Chapter 36: Inflammatory and Structural Heart Disorders

The nurse obtains a health history from an older adult with a prosthetic mitral valve who has symptoms of infective endocarditis. Which question by the nurse helps identify 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?"

d. "Have you had dental work done recently?"

What finding should the nurse expect during the assessment of a young adult with infective endocarditis?

a. substernal chest pressure

b. new regurgitant murmur

c. pruritic rash on the chest

d. involuntary muscle movement

b. new regurgitant murmur

Which assessment finding(s) indicate to the nurse that a patient with infective endocarditis has decreased cardiac output?

a. fever, chills, and diaphoresis

b. urine production of 25 mL/hr

c. increase in HR of 15 beats/min with walking

d. petechiae on the inside of the mouth and conjunctiva

b. urine production of 25 mL/hr

When planning care for a patient hospitalized with a streptococcal infective endocarditis, which intervention is 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

a. arrange for placement of a long-term IV catheter

A patient is admitted to the hospital with possible acute pericarditis. What diagnostic test would the nurse expect the patient to undergo?

a. blood cultures

b. echocardiography

c. cardiac catheterization

d. 24-hour Holter monitor

b. echocardiography

How should the nurse assess the patient with pericarditis for evidence of a pericardial friction rub?

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

b. auscultate with the diaphragm of the stethoscope on the lower left sternal border

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

a. subtract the diastolic blood pressure from the systolic blood pressure

b. note when Korotkoff sounds are heard during both inspiration and expiration

c. check the electrocardiogram 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

b. note when Korotkoff sounds are heard during both inspiration and expiration

A patient has pain due to acute pericarditis. What is an appropriate nursing intervention for this problem?

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. place the patient in Fowler's position, leaning forward on the table

d. provide a fresh ice bag every hour for the patient to place on the chest

c. place the patient in Fowler's position, leaning forward on the table

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 ever injured your chest?"

c. "Have you had a recent sore throat?"

d. "Do you have a family history of heart disease?"

c. "Have you had a recent sore throat?"

A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. The patient reports that joint discomfort prevents favorite activities such as taking a daily walk and sewing. What problem should be the focus of nursing interventions?

a. social isolation

b. general anxiety

c. activity intolerance

d. altered body image

c. activity intolerance

The home health nurse is visiting a 30-yr-old patient recovering from rheumatic fever without carditis. Which statement by the patient indicates a need for further teaching?

a. "I will need prophylactic antibiotic therapy for 5 years."

b. "I can take aspirin or ibuprofen 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."

c. "I will be immune to future episodes of rheumatic fever after this infection."

Which action should the nurse include in a community health program to decrease the incidence of rheumatic fever?

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

b. teach community members to seek treatment for streptococcal pharyngitis

Which finding for a patient with mitral valve stenosis would be of most concern to the nurse?

a. diastolic murmur

c. peripheral edema

c. SOB with exertion

d. right upper quadrant tenderness

c. SOB with exertion

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

c. lifelong anticoagulant therapy is needed after mechanical valve replacement

Which statement by a 23-yr-old patient who has mitral valve prolapse without valvular regurgitation indicates that discharge teaching has been effective?

a. "I will take antibiotics before any dental appointments."

b. "I will limit physical activity to avoid stressing the heart."

c. "I should avoid over-the-counter drugs that contain stimulants."

d. "I should take an aspirin a day to prevent clots from forming on the valve."

c. "I should avoid over-the-counter drugs that contain stimulants."

A patient with aortic stenosis has acute pain due to decreased coronary blood flow. What would be an appropriate nursing intervention for this patient?

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

a. promote rest to decrease myocardial oxygen demand

An older adult patient who had a mitral valve replacement with a mechanical valve is taking warfarin. What should the nurse include in discharge teaching?

a. use of daily aspirin for anticoagulation

b. correct method for taking the radial pulse

c. need for frequent laboratory blood testing

d. plan to avoid any physical activity for 1 month

c. need for frequent laboratory blood testing

A patient recovering from heart surgery develops pericarditis and reports level 6 chest pain with deep breathing. Which prescribed PRN medication will be the most appropriate for the nurse to give?

a. fentanyl 1mg IV

b. IV morphine sulfate 4mg

c. oral ibuprofen 600mg

d. oral acetaminophen 650mg

c. oral ibuprofen 600mg

What nursing assessment finding for a patient with infective endocarditis would be consistent with embolized vegetations from the tricuspid valve?

a. flank pain

b. splenomegaly

c. SOB

d. mental status changes

c. SOB

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

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

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

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

a. patient had a recent upper respiratory infection

b. patient has a family history of coronary artery disease

c. patient reports using cocaine "a few times" as a teenager

d. patient's 29-yr-old brother died from a sudden cardiac arrest

d. patient's 29-yr-old brother died from a sudden cardiac arrest

Which patient will need the nurse to plan discharge teaching about prophylactic antibiotics before dental procedures?

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

c. patient who had a mitral valve replacement with a mechanical valve

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

a. administer ceftriaxone 1g IV

b. order blood cultures from two sites

c. schedule a transesophageal echocardiogram

d. give acetaminophen PRN for fever

b. order blood cultures from two sites

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

a. muscle aching

b. right flank pain

c. Janeway's lesions on the palms

d. temperature 100.7° F (38.1° C)

b. right flank pain

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

a. pulsus paradoxus 8

b. BP of 168/94

c. JVD to jaw level

d. Level 6 chest pain with a deep breath

c. JVD to jaw level

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

a. patient reports chest pressure when ambulating

b. loud systolic murmur is heard along the right sternal border

c. thrill is palpated at the second intercostal space, right sternal border

d. the point of maximum impulse is at the left midclavicular line

a. patient reports chest pressure when ambulating

Two days after an acute myocardial infarction, a patient reports 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 PRN acetaminophen

d. notify the patient's health care provider

a. auscultate the heart sounds

The nurse is caring for a patient admitted with mitral valve regurgitation. Which information obtained by the nurse should be reported to the health care provider immediately?

a. patient has 4+ peripheral edema

b. patient has diffuse bilateral crackles

c. patient has a loud systolic murmur across the precordium

d. patient has a palpable thrill felt over the left anterior chest

b. patient has diffuse bilateral crackles

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

d. check the electrocardiogram for ST segment changes

c. assess for the presence of jugular venous distention

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 anti-inflammatory 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."

d. "I will take antibiotics before my teeth are cleaned at the dental office."

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

a. fatigue

b. leukocytosis

c. irregular pulse

d. generalized myalgia

c. irregular pulse

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

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

b. patient with acute aortic regurgitation whose blood pressure is 86/54

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 HR of 116

d. patient with a mitral valve replacement who has an anticoagulant scheduled

b. patient who has just returned to the unit after balloon valvuloplasty

Which action could the nurse delegate to unlicensed assistive personnel trained as electrocardiogram 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.

d. watch the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.