Question 1

While obtaining an admission health history from a patient with possible rheumatic fever, which question will be most pertinent to ask?

Accepted Answer

Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever and would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.

Question 2

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

Accepted Answer

The JVD indicates that the patient may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output. Hypertension would not be associated with complications of pericarditis, and the BP is not high enough to indicate that there is any immediate need to call the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10 chest pain should be treated but is not unusual with pericarditis.

Question 3

A 21-year-old woman is scheduled for an open mitral valve commissurotomy for treatment of mitral stenosis. When explaining the advantage of valve repair instead of valve replacement to the patient, the nurse will include the information that

Accepted Answer

Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and typically last longer than 10 years. Patients require prophylactic antibiotics when having invasive procedures after either valve repair or replacement. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.

Question 4

Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should

Accepted Answer

Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus.

Question 5

A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. An appropriate nursing diagnosis based on these findings is

Accepted Answer

The clinical manifestations of rheumatic fever include fatigue and arthralgia. The skin lesions seen in rheumatic fever are not open or pruritic. Joint inflammation is a temporary clinical manifestation of rheumatic fever.

Question 6

The nurse establishes the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge concerning long-term management of rheumatic fever when a patient recovering from rheumatic fever says,

Accepted Answer

Patients with a history of rheumatic fever are more susceptible to a second episode. The other patient statements are correct and would not support the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge.

Question 7

A patient hospitalized with a streptococcal infective endocarditis tells the nurse," I know that I need antibiotics, but I do not want to be hospitalized for very long." The nurse explains that

Accepted Answer

Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in order to eradicate the bacteria, but patients frequently receive IV antibiotics on an outpatient basis. Oral antibiotics do not result in the consistently high antibiotic level that is needed to eradicate the infective bacteria. The resolution of the fever is not an indication that the patient can be discharged or that oral antibiotics are adequate for treatment.

Question 8

A patient hospitalized with IE develops sharp left flank pain and hematuria. The nurse notifies the health care provider, recognizing that these symptoms may indicate

Accepted Answer

The patient's clinical manifestations and history of IE indicate embolization. Sudden onset flank pain is not typical of pyelonephritis, septicemia, or glomerulonephritis.

Question 9

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

Accepted Answer

Pericarditis causes changes such as ST segment elevation in multiple leads on the ECG, which evolve over the course of the inflammatory process. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization is not a diagnostic procedure for pericarditis. Pericardiocentesis will not be done unless the patient has symptoms of cardiac tamponade.

Question 10

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

Accepted Answer

The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in dyspnea and hemoptysis. Angina and syncope are associated with aortic stenosis. JVD and peripheral edema are more common in right-sided valvular disorders. Hypotension and PND suggest aortic regurgitation.

Question 11

During the assessment of a patient with IE, the nurse would expect to find

Accepted Answer

New regurgitant murmurs occur in IE because vegetation on the valves prevents valve closure. Splinter hemorrhages occur on the nailbeds. Chest pain for pressure is not typical for the patient with IE and would be more consistent with angina or MI. Although dyspnea may occur as a result of heart failure, a moist cough would be expected rather than a dry, hacking cough.

Question 12

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

Accepted Answer

Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep respirations tends to increase pericardial pain. Opioids are not very effective at controlling pain caused by acute inflammatory conditions and are usually ordered PRN. The patient would receive scheduled doses of a nonsteroidal antiinflammatory drug (NSAID).

Question 13

The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis. Which question by the nurse is most appropriate?

Accepted Answer

Dental procedures place the patient with a prosthetic mitral valve at risk for infectious endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE.

Question 14

While caring for a patient with mitral valve prolapse with mild valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient tells the nurse she will

Accepted Answer

Mitral valve prolapse with regurgitation is a risk factor for infective endocarditis, and the patient needs to discuss the need for antibiotic prophylaxis with the provider before any invasive medical or dental procedure is done. Anticoagulation, restriction of physical activity, and frequent medical appointments are not required for mild mitral valve prolapse.

Question 15

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with IE based on the assessment finding of

Accepted Answer

Decreased renal perfusion caused by inadequate cardiac output will lead to poor urine output. Petechiae, fever, chills, and diaphoresis are symptoms of IE but are not caused by decreased cardiac output. An increase in pulse rate of 15 beats/min is normal with exercise

Question 16

The health care provider writes the following admitting orders for a patient with suspected IE who has fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous piggyback (IVPB) q12hr, acetylsalicylic acid (ASA) for temperature above 102° F (38.9° C), and blood cultures * 2, complete blood cell count (CBC), and electrocardiogram (ECG). When admitting the patient, the nurse gives the highest priority to

Accepted Answer

Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before initiating antibiotic therapy to obtain accurate sensitivity results. The ECG and ASA should also be accomplished rapidly, but the blood cultures (and then administration of the antibiotic) have highest priority.

Question 17

Which assessment information obtained by the nurse for a patient with aortic stenosis would be most important to report to the health care provider?

Accepted Answer

Chest pain occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill would not be unusual for a patient with aortic stenosis. A PMI at the left midclavicular line is normal.

Question 18

While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of pain related to decreased coronary blood flow. An appropriate intervention by the nurse is to

Accepted Answer

Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

Question 19

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

Accepted Answer

Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. Because dyspnea is one clinical manifestation of pericarditis, the nurse should time the friction rub with the pulse rather than ask the patient to stop breathing during auscultation. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.

Question 20

The community health nurse involved in programs to prevent rheumatic fever knows that the most important intervention to decrease the incidence of the disease is

Accepted Answer

The incidence of rheumatic fever is decreased by treatment of streptococcal infections with antibiotics. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Hygienic measures may help to decrease the spread of streptococcal infections but is not the primary means of decreasing risk for rheumatic fever.

Quiz 37: Nursing Management: Inflammatory and Structural Heart Disorders