Question 1

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

Accepted Answer

Positioning the patient in a Fowler's position, leaning forward on a padded overbed table, can relieve pain and dyspnea associated with acute pericarditis. This position minimizes pressure on the heart and decreases the stretching of the pericardium. Forcing fluids may be appropriate for other conditions, but it is not specific to relieving pain from acute pericarditis. Teaching deep, slow respirations may be appropriate for other respiratory conditions, but it is not specific to pericarditis pain relief. Providing patient-controlled analgesia with a narcotic analgesic may be appropriate for severe pain, but it is not the initial intervention for acute pericarditis pain.

Question 2

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

Accepted Answer

Chest pain associated with ambulation in a patient with aortic stenosis may indicate decreased blood flow to the heart and is a sign of potential angina or myocardial ischemia. This information should be communicated to the physician promptly. While other assessment findings may be important, such as a loud systolic murmur or palpable thrill, they are not indicative of immediate or acute changes in the patient's condition.

Question 3

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

Accepted Answer

A new regurgitant murmur is a common clinical manifestation of infective endocarditis (IE). The infected heart valve(s) may not function properly due to the impairment caused by the infection, leading to the development of a new murmur.

Answer: B
 Splinter hemorrhages of the nails, not lips, are commonly seen in patients with IE. These are small reddish-brown linear lesions that run parallel to the long axis of the nail and are caused by microemboli migrating to the nail bed.

Answer: C
 Dyspnea and cough are not typical findings in IE. These symptoms may be seen in respiratory or other cardio-pulmonary disorders.

Answer: D
 Substernal chest pain and pressure are not typical findings in IE. These symptoms may suggest angina, myocardial infarction, or other cardiac conditions.

Question 4

A patient hospitalized with a streptococcal IE tells the nurse that the physician said treatment would require 4 to 6 weeks of antibiotic therapy and says she needs to get back to work as soon as possible.In advising the patient about the expected regimen for IE,what should the nurse explain about the treatment?

Accepted Answer

Outpatient IV antibiotic therapy with home nursing care is often possible for patients with infective endocarditis (IE) if they are stable and complications do not develop, allowing them to continue treatment outside the hospital.

Question 5

The physician writes the following admitting orders for a patient with suspected IE who has fever and chills: ceftriaxone (Rocephin)1.0 g intravenous (IV)piggyback every 12 hours,aspirin for a temperature above 38.9°C,blood cultures ? 3,complete blood count,and electrocardiogram (ECG).When admitting the patient,to which of the following orders should the nurse give the highest priority?

Accepted Answer

Obtaining blood cultures before starting antibiotics is crucial for identifying the causative organism in infective endocarditis (IE), which guides appropriate antibiotic therapy.

Question 6

A 22-year-old patient with rheumatic fever has subcutaneous nodules,erythema marginatum,and polyarthritis of multiple joints.What would the nurse document as an appropriate nursing diagnosis based on these findings?

Accepted Answer

Activity intolerance related to fatigue and arthralgia is the most appropriate nursing diagnosis given the symptoms of rheumatic fever, which include polyarthritis causing joint pain and potential fatigue.

Question 7

A patient is admitted to the hospital with possible acute pericarditis.The nurse explains to the patient that to confirm a diagnosis of acute pericarditis,the physician will most likely use which of the following tests?

Accepted Answer

The most common initial test to diagnose acute pericarditis is performing multiple electrocardiograms (ECGs) to look for specific changes in the heart's electrical activity, which are characteristic of the disease. Blood cultures may be ordered to check for any infection, but they are not necessary to confirm the diagnosis. Cardiac catheterization is an invasive procedure and is not required for the diagnosis of acute pericarditis. Fluid obtained by pericardiocentesis is used to relieve symptoms, but it is not always necessary for diagnosis.

Question 8

While obtaining a nursing history from a 23-year-old man with rheumatic fever,what information related by the patient does the nurse recognize as the most significant?

Accepted Answer

Rheumatic fever is a complication of untreated streptococcal infection, so a recent sore throat is significant as it could indicate a strep infection that was not treated with antibiotics. The other options may have potential health concerns, but they are not directly related to the patient's current diagnosis of rheumatic fever.

Question 9

A patient who is hospitalized with IE develops sharp left flank pain and hematuria.The nurse notifies the physician,recognizing that these symptoms may indicate which of the following complications?

Accepted Answer

The sharp left flank pain and hematuria may indicate that there is a vegetative embolus that has lodged in the renal artery, leading to ischemia and infarction of the kidney tissue. This complication can occur in patients with IE when the vegetations on the heart valves break off and travel to other parts of the body through the bloodstream. Bacterial colonization in the kidneys (A) may cause urinary tract infections, but these usually do not present with flank pain and hematuria. Septicemia resulting in decreased glomerular blood flow (C) may cause acute kidney injury, but it is unlikely to present with flank pain and hematuria. Hemolysis of red blood cells by hemolytic microorganisms (D) may occur in some cases of IE, but it is not a common cause of flank pain and hematuria.

Question 10

To assess the patient with pericarditis for the presence of a pericardial friction rub,the nurse should undertake which of the following actions?

Accepted Answer

The nurse should place the diaphragm of the stethoscope at the lower left sternal border of the chest to listen for a pericardial friction rub. The sound of the rub is typically high-pitched, scratchy, and heard best with the diaphragm of the stethoscope. The nurse should not ask the patient to stop breathing during auscultation as this will not help to distinguish the sound from a pleural rub. The nurse should also not use the diaphragm of the stethoscope to listen for a rumbling, low-pitched sound during systole or palpate the precordial area with the tips of the fingers to detect a vibration that occurs with each cardiac contraction as these are unlikely to help detect a pericardial friction rub.

Question 11

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

Accepted Answer

Pulsus paradoxus is assessed by noting a decrease in systolic blood pressure of more than 10 mm Hg during inspiration. This is done by measuring blood pressure and observing the point at which the first Korotkoff sound is heard during both inspiration and expiration while deflating the blood pressure cuff.

Question 12

The nurse suspects the development of cardiac tamponade in a patient with acute pericarditis on finding which of the following data?

Accepted Answer

Jugular vein distension (JVD) is a classic sign of cardiac tamponade, indicating increased venous pressure due to the heart's inability to properly fill and pump because of the fluid accumulation in the pericardial sac.

Question 13

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 that she will do which of the following?

Accepted Answer

Patients with mitral valve prolapse should inform their dentist about their condition due to the potential need for antibiotic prophylaxis before dental procedures to prevent infective endocarditis.

Question 14

The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE).Which is the most appropriate question for the nurse to ask?

Accepted Answer

Patients with prosthetic heart valves are at increased risk for infective endocarditis, which can be caused by dental procedures, among other things. Therefore, it is important to ask about recent dental visits to determine if prophylactic antibiotics are warranted. A history of heart attack or family history of endocarditis is not as directly relevant to the current symptoms, and recent immunizations may not be as relevant unless they are specifically related to prevention of infectious diseases that could lead to IE.

Question 15

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

Accepted Answer

The most important intervention to decrease the incidence of rheumatic fever is to promote the early diagnosis and treatment of streptococcal pharyngitis, which is the trigger for most cases of rheumatic fever. Immunizing susceptible individuals with the streptococcal vaccine and providing prophylactic antibiotics to those with a family history of rheumatic fever are secondary interventions that may be helpful but are not as important as early diagnosis and treatment of streptococcal infections. Promoting hygienic measures to prevent the transmission of streptococcal infections is also important but not as crucial as early intervention for identified streptococcal infections.

Question 16

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 endocarditis makes which of the following remarks?

Accepted Answer

The statement "I will be immune to further episodes of rheumatic fever after this infection." indicates a lack of knowledge concerning the long-term management of rheumatic fever. Rheumatic fever can recur, and patients are not immune to further episodes after an initial infection.

Question 17

Which pulse pattern would the nurse expect to diagnose on assessment of a patient who has mitral valve regurgitation?

Accepted Answer

The answer of Which pulse pattern would the nurse expect...

Question 18

During assessment of a patient with mitral valve stenosis,which findings would the nurse recognize are characteristic of the pressure gradient differences occurring with mitral valve stenosis?

Accepted Answer

Dyspnea and hemoptysis are characteristic findings of mitral valve stenosis due to the pressure gradient differences that occur between the left atrium and ventricle. Angina and syncope are not commonly associated with this condition, while JVD and peripheral edema are more commonly associated with right-sided heart failure. Hypotension and paroxysmal nocturnal dyspnea are also not commonly associated with mitral valve stenosis.

Question 19

A 21-year-old female student is scheduled for an open mitral valve commissurotomy for treatment of a mitral stenosis resulting from rheumatic endocarditis when she was a child.Which factor supports the choice of valve repair over valve replacement in this patient?

Accepted Answer

The answer of A 21-year-old female student is scheduled for...

Question 20

A patient is admitted to hospital with a diagnosis of myocarditis.The nurse knows that early cardiac manifestations will appear approximately how long after viral infection?

Accepted Answer

Early cardiac manifestations of myocarditis typically appear 7 to 10 days after a viral infection.

Quiz 39: Nursing Management: Inflammatory and Structural Heart Disorders