Deck 33: Caring for the Patient With Cardiac Inflammatory Disorders

Question 1

A patient with endocarditis develops sudden leg pain with pallor, tingling, and a loss of peripheral pulses. What should be the initial nursing intervention?

A) Notify the physician about these findings.
B) Elevate the leg above the level of the heart.
C) Administer prn analgesia.
D) Perform passive range-of-motion (PROM) exercises to stimulate circulation.

Answer 1

Notify the physician about these findings.

Question 2

The nurse is providing discharge instructions to a patient diagnosed with severe aortic stenosis. What should the nurse teach the patient about returning to activity?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "A balanced diet will provide the calories you need for activity."
B) "Plan to increase your activity level by about 10% each week."
C) "If you have chest pain or shortness of breath, sit down and rest immediately."
D) "You will be able to exercise more if you wear oxygen."
E) "Find sedentary activities you enjoy."

Answer 2

"A balanced diet will provide the calories you need for activity."
"If you have chest pain or shortness of breath, sit down and rest immediately."
"Find sedentary activities you enjoy."

Question 3

The nurse is admitting a patient with a sudden onset of dyspnea and a blowing high-pitched murmur. The nurse is most concerned about which condition?

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

Answer 3

Acute mitral valve regurgitation

Question 4

Cardiac tamponade is suspected in a patient diagnosed with pericarditis. What assessment data would assist the nurse in determining the presence of this complication?

A) Changes in systolic blood pressure during inspiration
B) Arterial blood gases
C) The rhythm of the pulse in relation to inspiration and expiration
D) A cardiac murmur that occurs during systole

Question 5

The nurse implements the following measures for a patient with rheumatic fever: turn, cough, deep breathe, elevate head of bed, instruct on use of incentive spirometry. On which parameters would the nurse assess the effectiveness of the nursing interventions?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Urine output
B) Arterial blood gases
C) Potassium level
D) Lung sounds
E) Orientation

Question 6

The nurse, caring for a patient diagnosed with cardiac tamponade, prepares to participate in which initial treatment?

A) Antidysrhythmic drugs and oxygen
B) Oxygen and rest
C) Pericardiocentesis
D) Antibiotics

Question 7

The nurse has provided discharge education for a patient who had valve replacement surgery and is on warfarin. Which statement by the patient would indicate understanding of the nurse's instruction?

A) "I need to report bruising, bleeding, epistaxis, and hemoptysis to my health care provider."
B) "I should take aspirin and anti-inflammatory drugs (NSAIDs) for pain."
C) "I should avoid red meat."
D) "I need to eat large amounts of yellow and dark green vegetables."

Question 8

Following valve replacement surgery, the patient is instructed to notify the health care provider if fever, increased heart rate, fatigue, malaise, anorexia, weight loss, headache, chills, and/or night sweats occur. What is the nurse's rationale for this instruction?

A) These are manifestation of valve rejection.
B) These are manifestations of the type of heart failure associated with valve replacement.
C) These findings suggest that the patient is having a myocardial infarction.
D) These findings are manifestations of infective endocarditis.

Question 9

Diagnostic testing reveals that an adult patient has a stenotic mitral valve. How would the nurse explain this diagnosis to the patient?

A) "One of the valves of your heart does not open well enough."
B) "You have a leaky valve in your heart."
C) "The valves in your heart were not formed correctly before you were born."
D) "One of the valves in your heart is stuck in the open position."

Question 10

A nurse caring for a patient with coronary artery disease (CAD) hears a murmur during auscultation of the heart. The nurse suspects which complication of CAD?

A) Valvular heart disease
B) Pericarditis
C) Cardiac tamponade
D) Heart failure

Question 11

The nurse caring for patients on a cardiac unit should plan to see which assigned patient first?

A) A patient with hypertrophic cardiomyopathy who is reporting dyspnea
B) A patient who had a cardiac catheterization and will be ambulating for the first time
C) A patient receiving antibiotics for bacterial endocarditis who is reporting dyspnea and chest pain
D) A patient who is recovering from coronary artery bypass grafting (CABG) surgery with a temperature of 101°F

Question 12

A patient is admitted with acute pericarditis. When auscultating heart sounds, the nurse should ask the patient to assume which position?

A) Sit leaning forward
B) Lie supine
C) Sit upright
D) Lie on the left side

Question 13

Home care teaching is being completed by the nurse for a patient recovering from rheumatic fever. Which statement by the patient would indicate that the teaching has been effective?

A) "I will be sure to tell my dentist that I had rheumatic fever."
B) "I will try to eat less protein and more fat, so I will have more energy."
C) "I am already at risk for increased bleeding, so I will avoid taking aspirin for pain."
D) "I know that if my joints start to hurt again, I need to slow down, but I won't have to worry since I'm immune to getting rheumatic fever again."

Question 14

A patient with mitral regurgitation is instructed to report to the health care provider if it becomes too difficult to perform activities of daily living. What is the nurse's rationale for providing this instruction?

A) Activity intolerance indicates acute respiratory distress.
B) The patient may have experienced a myocardial infarction.
C) These changes indicate that it is time to consider valve replacement.
D) Infective endocarditis is developing.

Question 15

Which information should the nurse consider when planning care for patients at risk for endocarditis?

A) Endocarditis does not pose a high risk for damage to affected heart valves.
B) The major treatment modality for endocarditis is open heart surgery to clean the heart valves.
C) Fever is a rare manifestation of endocarditis.
D) Endocarditis can be prevented in patients at risk by administering antibiotics prior to procedures.

Question 16

A nurse is caring for a patient diagnosed with pericarditis. Due to this patient's risk for cardiac tamponade, the nurse is vigilant about assessing for which findings?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Heart sounds that are more difficult to auscultate
B) A palpable lift at the third intercostal space just left of the midclavicular line
C) Decreased systolic blood pressure
D) Visible distention of jugular veins
E) Patient report of headache

Question 17

Pain is associated with inflammatory heart disease. What interventions should be included in an effective management plan to keep the patient pain-free?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Instruct the patient to inform the nurse if pain is not relieved.
B) Have the family manage the patient's pain.
C) Medicate the patient only when the pain is severe.
D) Instruct the patient that there is a risk of addiction and overdose.
E) Provide a supportive environment in which the patient is able to express his or her pain level.

Question 18

A patient is being discharged from the health care facility following surgical replacement of a mitral valve with a mechanical valve. The patient asks the nurse how much longer he will need to take warfarin (Coumadin). What is the nurse's best response?

A) "You will be on it for the rest of your life because you have a mechanical valve."
B) "That will depend on your surgeon. Ask at your office visit."
C) "You will need to take it until the valve covers over with tissue."
D) "Your surgeon will help wean you off the warfarin in about 3 months."

Question 19

Which assessment findings would increase the nurse's suspicion that a patient may have pericarditis?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Pericardial friction rub
B) Abdominal discomfort and nausea
C) Chest pain
D) Bradycardia
E) Distended neck veins

Question 20

A patient being admitted for valvular annuloplasty says, "I still don't understand why I need my valve replaced now. I've had this floppy valve for years." How should the nurse respond?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "You are not having the valve replaced; you are having the fibrous ring at the junction of the valve leaflets and the muscular wall repaired."
B) "You are having your valve replaced because it is diseased."
C) "Due to valve stenosis, the valve leaflets must be separated."
D) "Your family has been informed of the procedure."
E) "What did your surgeon tell you about the procedure?"

Question 21

A patient is diagnosed with hypertrophic obstructive cardiomyopathy. The nurse would design interventions to meet which primary collaborative treatment goals for this patient?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Preventing sudden cardiac death
B) Preventing renal failure
C) Preventing pulmonary damage
D) Preventing heart failure
E) Preventing liver failure

Question 22

A patient has been admitted for treatment of acute pericarditis. The nurse would include which nursing diagnoses in this patient's plan of care?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Anxiety
B) Decreased Cardiac Output
C) Risk for Impaired Skin Integrity
D) Ineffective Tissue Perfusion
E) Activity Intolerance

Question 23

The nurse is admitting a 22-year-old patient who is experiencing palpitations, light-headedness, and fatigue. The health care provider has diagnosed cardiomyopathy. The nurse would ask additional questions about which most likely form of cardiomyopathy?

A) Restrictive
B) Arrhythmogenic right ventricular cardiomyopathy
C) Dilated cardiomyopathy
D) Hypertrophic cardiomyopathy

Question 24

The nurse is assessing a patient diagnosed with dilated cardiomyopathy for progression of the disease. The nurse would focus questioning on which most common symptom?

A) Confusion
B) Cyanosis
C) Dyspnea
D) Peripheral edema

Question 25

While taking a nursing history of a patient recently diagnosed with restrictive cardiomyopathy, which information does the nurse recognize as significant to this health problem?

A) A history of cocaine abuse
B) A family history of cardiomyopathy
C) History of depression
D) History of excessive alcohol use

Question 26

The nurse is reviewing physician orders for a patient who has been admitted for the treatment of myocarditis. The nurse would contact the prescriber regarding which medication orders?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Ibuprofen
B) Digoxin
C) An antibiotic
D) An ACE inhibitor
E) Antidysrhythmic

Question 27

The nurse is developing a program to support patients with cardiac valve disease, both before and after surgical intervention. For this program to be holistic, members from which disciplines should be included on the planning committee?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Dieticians
B) Nurses and health care providers
C) Laboratory technicians
D) Psychologists/psychiatrists
E) Pharmacists

Question 28

A young male athlete is admitted to the hospital after collapsing at football practice. The medical diagnosis is hypertrophic obstructive cardiomyopathy. The nurse expects that which activity recommendation will be necessary?

A) The patient should limit fluid intake while exercising.
B) The patient should stop playing football and other strenuous sports.
C) The patient will need to gradually return to previous levels of exercise.
D) Exercise is not related to hypertrophic cardiomyopathy symptomology.

Question 29

The medical record states that a patient with infective endocarditis has Osler's nodes. The nurse would assess the patient for which finding?

A) Enlarged lymph nodes in the axilla
B) Painful mobile enlargement of the posterior lymph node chain in the neck
C) Painful red or purple lesions on the fingertips or toes
D) Round white spots on the retina

Question 30

Which nursing diagnosis will the nurse include as the priority in the care plan of a patient diagnosed with hypertrophic cardiomyopathy (HCM)?

A) Risk for Activity Intolerance
B) Ineffective Airway Clearance
C) Imbalanced Nutrition: More than Body Requirements
D) Ineffective Individual Coping

Question 31

The nurse calls a patient 2 days before an outpatient procedure to discuss preprocedure preparation. The procedure is being done to track the progression of the patient's valvular disease. Which testing is likely scheduled?

A) Chest x-ray
B) An electrocardiogram
C) Transesophageal echocardiography (TEE)
D) Cardiac catheterization

Question 32

A patient with infective endocarditis is expressing fear and anxiety related to changes in health status and anticipated procedures. What interventions would the nurse include in this patient's care plan?.Note: Credit will be given only if all correct choices and no incorrect choices are selected.. Select all that apply.

A) Provide factual information concerning diagnosis, treatment, disfigurement, disabilities, and prognosis.
B) State that the physician will have to be the one who talks to the patient about the procedure.
C) Explain to the patient that it is better not to be informed prior to procedures, as information increases anxiety.
D) Tell the patient not to worry and that everything will be fine.
E) Explain all procedures and allow the patient time for mental preparation.

Question 33

A patient is considering valve replacement surgery. The nurse would explain which main differences between biological and mechanical valves?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Biological valves have a higher incidence of clot formation than do mechanical valves.
B) Biological valves wear out faster than mechanical valves.
C) Mechanical valves sometimes have an audible click.
D) Infections are harder to treat in mechanical valves.
E) There is a higher risk of hemorrhage in the years after surgery if a biologic valve is used.

Question 34

A patient who requires a valve replacement says, "The surgeon wants to use a mechanical valve, but I think I would rather have a human valve." What information should the nurse provide?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Human valves are not used for valve replacements.
B) Cadaver valves are more durable than mechanical valves.
C) Human valves are very expensive.
D) Anticoagulation is rarely needed with human valve transplant.
E) The patient should talk with the surgeon about the use of allograft valves.

Question 35

The nurse is evaluating activity tolerance in a patient with mitral valve stenosis. Which finding would the nurse evaluate as indicating the patient tolerated ambulating in the hall?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The heart rate, measured 3 minutes after the patient returned to bed, was at the patient's normal level.
B) Blood pressure taken at the halfway point of ambulation was not significantly different from the preambulation level.
C) The patient does not complain of being tired when ambulating.
D) The patient's pulse oximetry reading goes up slightly right after ambulation.
E) The patient's respiratory rate is at normal level at the end of the walk.