Chapter 24

Flashcards for review of cardiac disorders

A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, what heart rhythm would the nurse expect?

a) Ventricular Tachycardia
b) Sinus Bradycardia
c) Atrial Fibrillation
d) First-degree heart block

Atrial Fibrillation

Rationale: The most common dysrhythmia associated with mitral stenosis is atrial fibrillation. The increase in left atrial pressure and resultant atrial dilation that occurs in mitral stenosis predisposes the patient to atrial fibrillation.

A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?

a) Elective cosmetic surgery
b) Dental procedures involving manipulation of gingival tissue
c) Massage therapy
d) Air travel

Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue.

Rationale: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue to prevent infective endocarditis.

A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit and takes over-the-counter water pills regularly. How should the nurse best respond to the fact that the patient has been taking diuretics?

a) Educate the patient about the need to reduce fluid intake to potentiate the effects of the diuretic.
b) No action is needed because over-the-counter medications are safe by definition.
c) The care provider should be informed because diuretics are contraindicated in patients with HCM.
d) Encourage the patient to increase the dose if edema is present.

The care provider should be informed because diuretics are contraindicated in patients with HCM.

Rationale: Diuretics are contraindicated in patients with HCM because a reduction in blood volume may worsen the outflow obstruction.

The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond?

a) Promote vasodilation to improve blood flow to the heart.
b) Treat hypertension and reduce the workload of the heart.
c) Prevent the formation of clots in the coronary arteries.
d) Minimize rejection of the transplant.

Minimize rejection of the transplant.

Rationale: Cyclosporine is an immunosuppressant drug that is used to prevent rejection of the transplanted heart.

A patient with a history of rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs?

a) A daily multivitamin
b) Amoxicillin (Amoxil)
c) Aspirin
d) Vitamin K

Amoxicillin (Amoxil)

Rationale: Patients at risk for bacterial endocarditis, such as those with a history of rheumatic heart disease, should receive antibiotic prophylaxis (e.g., amoxicillin) before invasive procedures.

A patient with pericarditis has just been admitted to the CCU. The nurse planning the patients care should prioritize what nursing diagnosis?

a) Risk for imbalanced body temperature related to inflammation
b) Activity intolerance related to decreased cardiac output
c) Acute pain related to pericarditis
d) Ineffective airway clearance related to increased secretions

Acute pain related to pericarditis

Rationale: The pain associated with pericarditis is often severe and exacerbated with breathing; therefore, pain management is a priority.

A patient is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient?

a) Aortic regurgitation
b) Mitral stenosis
c) Aortic stenosis
d) Mitral valve prolapse

Mitral stenosis

Rationale: Pulmonary venous hypertension develops if chronic mitral stenosis exists. This leads to symptoms of progressive fatigue, hemoptysis, and dyspnea.

The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite?

a) Valvuloplasty has a lower risk of endocarditis than valve replacement.
b) Valvuloplasty can be performed on an outpatient basis.
c) Repaired valves tend to function longer than replaced valves.
d) Valvuloplasty has a lower risk of bleeding than valve replacement.

Repaired valves tend to function longer than replaced valves.

Rationale: An advantage of valvuloplasty is that repaired valves tend to function longer than replaced valves, have a lower incidence of thromboembolism, and do not require long-term anticoagulation.

The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM?

a) Dilated atria with constriction of the ventricles
b) Dilated ventricles without hypertrophy of the ventricles
c) Hypertrophy of all four chambers of the heart
d) Hypertrophy of the atria with enlargement of the ventricles

Dilated ventricles without hypertrophy of the ventricles

Rationale: DCM is characterized by dilation of the ventricles without simultaneous hypertrophy.

A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physicians choice of antibiotics would be primarily based on what diagnostic test?

a) Complete blood count (CBC)
b) Urine analysis
c) Blood cultures
d) White blood cell (WBC) differential

Blood cultures

Rationale: Blood cultures are essential in the diagnosis of endocarditis because they identify the causative agent that informs antibiotic selection.

A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease?

a) Avoiding contact with people who have upper respiratory infections
b) Ensuring adequate nutrition and rest among school-age children
c) Receiving prompt treatment for sinus infections
d) Recognizing and promptly treating streptococcal infections

Recognizing and promptly treating streptococcal infections

Rationale: The most effective way to prevent rheumatic heart disease is to recognize and promptly treat streptococcal infections. Untreated or partially treated streptococcal infections can lead to rheumatic fever which can cause rheumatic heart disease.

A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this?

a) To maintain a patent airway during the procedure
b) To prevent bacterial endocarditis
c) To prevent a hypersensitivity reaction to the anesthetic
d) To reduce inflammation of the bronchioles

To prevent bacterial endocarditis

Rationale: Patients with mitral valve prolapse do not usually require antibiotic prophylaxis before bronchoscopy. However, because the patient is admitted for hemoptysis, bacterial endocarditis is a risk.

The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patients ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy?

a) Chest x-ray
b) Pulmonary function tests
c) Echocardiogram
d) Arterial blood gases (ABGs)

Echocardiogram

Rationale: An echocardiogram assists in confirming the diagnosis of cardiomyopathy. The ECG may show dysrhythmias and is sometimes associated with left ventricular hypertrophy. The chest x-ray may show cardiomegaly and pulmonary congestion.

The nurse is preparing a patient for cardiac surgery. During the procedure, the patients heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?

a) Heterotopic transplant
b) Orthotopic transplant
c) Xenograft
d) Ventricular assist device (VAD) implantation

Orthotopic transplant

Rationale: An orthotopic transplant involves removing the recipients heart and implanting the donor heart in its place.

A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurses interview is most suggestive of this valvular disorder?

a) I feel like I am going to pass out if I stand up too quickly.
b) I find that I have to sleep propped up on three or four pillows at night.
c) I have had a fever off and on for the past several weeks.
d) Whenever I do any form of exercise I get terribly short of breath.

Whenever I do any form of exercise I get terribly short of breath.

Rationale: Dyspnea on exertion is a common manifestation of mitral stenosis and results from pulmonary congestion.

The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following?

a) A low-sodium, low-fat diet
b) Daily aerobic exercise
c) Daily weights
d) Long-term anticoagulant therapy

Long-term anticoagulant therapy

Rationale: Patient education following mechanical valve replacement must include the need for long-term anticoagulant therapy.

The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what?

a) Right ventricular hypertrophy
b) Left ventricular hypertrophy
c) Right atrial enlargement
d) Pulmonary hypertension

Left ventricular hypertrophy

Rationale: Aortic regurgitation causes blood from the aorta to flow back into the left ventricle during diastole. In response, the left ventricle dilates and hypertrophies.

The nurse is creating a plan of care for a patient with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this patient?

a) Effective coping skills
b) Adherence to self care
c) Improved cardiac output
d) Adequate nutritional intake

Improved cardiac output

Rationale: The primary goal for a patient with cardiomyopathy is to improve cardiac output. Therefore, all assessments and interventions should be selected in an effort to meet this goal.

An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patients echocardiogram?

a) Blood to flow back from the aorta to the left ventricle
b) Blood to flow from the left ventricle to the left atrium
c) Blood to flow back from the right atrium to the vena cava
d) Blood to flow back from the left atrium to the pulmonary veins

Blood to flow back from the aorta to the left ventricle

Rationale: Aortic regurgitation is characterized by blood flowing back from the aorta to the left ventricle.

A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following?

a) Strategies for minimizing the risk of deep vein thrombosis (DVT)
b) The signs and symptoms of pulmonary embolism
c) The need to avoid strenuous activity
d) The need for regularly scheduled testing of the patients International Normalized Ratio (INR)

The need for regularly scheduled testing of the patients International Normalized Ratio (INR)

Rationale: Patients taking warfarin require regularly scheduled blood tests to ensure that their INR remains within the target range.

A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge?

a) Strategies for infection prevention
b) Management of activity intolerance
c) Strategies for minimizing surgical pain
d) Management of anticoagulant therapy

Strategies for infection prevention

Rationale: The nurse should prioritize teaching the patient strategies for the prevention of infection to decrease the risk of endocarditis.

A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patients symptoms, the nurse should teach the patient to do which of the following?

a) Report any episodes of paroxysmal nocturnal dyspnea to the physician promptly.
b) Take prophylactic antibiotics before dental appointments.
c) Remain on bed rest as much as possible.
d) Avoid activities that cause an increased heart rate.

Avoid activities that cause an increased heart rate.

Rationale: The patient should be taught to avoid activities that cause an increased heart rate because tachycardia shortens the diastolic filling time and may cause a decrease in cardiac output.

A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patients most recent laboratory results, the nurse should prioritize assessment of which of the following?

a) Potassium
b) Sodium
c) Creatinine
d) Liver enzymes

Sodium

Rationale: The nurse should prioritize assessment of sodium because heart failure is the most common complication of cardiomyopathy, and sodium retention is often associated with heart failure.

A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty. The patient also has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse?

a) Administer a mild sedative.
b) Reassure the patient that the table will be adjusted for maximum comfort.
c) Administer pain medication before the procedure.
d) Notify the surgeon immediately.

Notify the surgeon immediately.

Rationale: The surgeon should be immediately notified. Lying flat for an extended period of time may be contraindicated in patients with aortic valve stenosis and can cause hemodynamic instability

A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient?

a) Youll likely need to take a leave of absence from work for about a month.
b) Youll be in the hospital for at least a week, maybe longer if there are complications.
c) Patients usually remain at the hospital for 24 to 48 hours.
d) The surgeon may want you to have a short stay in a rehabilitation facility.

Patients usually remain at the hospital for 24 to 48 hours.

Rationale: Percutaneous balloon valvuloplasty is associated with a relatively short hospital stay, usually 24 to 48 hours. This may be reassuring to the patient.

A patient has been diagnosed with a valvular disorder and has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty?

a) Valve repair is typically more durable than valve replacement.
b) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.
c) The long-term outcomes are usually better than those associated with long-term medical management.
d) Long-term anticoagulation is not needed following valvuloplasty.

For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.

Rationale: Valvuloplasty may be performed in a cardiac catheterization laboratory. The other statements are also true but do not teach the patient about valvuloplasty.

The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should know that complications following this procedure include what? Select all that apply.

a) Emboli
b) Pericardial effusion
c) Mitral valve damage
d) Ventricular dysrhythmia
e) Cardiac tamponade

Emboli - Rationale: Emboli is a complication after the procedure.
Mitral valve damage - Rationale: Mitral valve damage is a complication after the procedure.
Ventricular dysrhythmia - Rationale: Ventricular dysrhythmia is a complication after the procedure.

The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patients diagnosis?

a) Aortic valve regurgitation
b) Tricuspid valve stenosis
c) Mitral valve stenosis
d) Pulmonic valve regurgitation

Mitral valve stenosis

Rationale: Mitral valve stenosis obstructs blood flow from the left atrium into the left ventricle, causing increased pressure in the left atrium and pulmonary vasculature. This can lead to right ventricular hypertrophy and decreased right ventricular function.

The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding?

a) Increased stroke volume
b) Decreased ejection fraction
c) Increased ventricular wall thickness
d) Normal ventricular size

Decreased ejection fraction

Rationale: DCM is characterized by impaired systolic function, decreased ejection fraction, and increased end-systolic and end-diastolic volumes.

A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy?

a) Restrictive cardiomyopathy
b) Arrhythmogenic right ventricular cardiomyopathy
c) Dilated cardiomyopathy (DCM)
d) Hypertrophic cardiomyopathy (HCM)

Hypertrophic cardiomyopathy (HCM)

Rationale: Hypertrophic cardiomyopathy (HCM) is a relatively common cause of cardiac arrest in young people, including athletes. It is often undiagnosed prior to the event.

The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?

a) To perform isometric exercises before taking nitroglycerin
b) To take a nitroglycerin tablet before engaging in activity
c) To rest and relax before taking nitroglycerin
d) To increase fluid intake before taking nitroglycerin

To rest and relax before taking nitroglycerin

Rationale: By resting and relaxing, the patient reduces myocardial oxygen demand. This may reduce the need for drugs.

A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment?

a) Percutaneous transluminal coronary angioplasty (PTCA)
b) Implantation of a cardioverter/defibrillator
c) Administration of dobutamine by continuous IV infusion
d) Heart transplantation

Heart transplantation

Rationale: Heart transplantation occurs when other measures have failed to improve a patients quality of life.

A patient has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus. In light of this patients medication regimen, what nursing diagnosis should be prioritized?

a) Risk for unstable blood glucose
b) Risk for deficient fluid volume
c) Risk for imbalanced nutrition
d) Risk for infection

Risk for infection

Rationale: Both cyclosporine and tacrolimus are immunosuppressant medications and increase the patients risk for infection.

The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications?

a) The nurse administers nonsteroidal anti-inflammatory drugs (NSAIDs) around the clock to prevent recurrence of fever.
b) The nurse encourages the patient to cough and deep breathe every 2 hours to prevent atelectasis.
c) The nurse closely monitors central venous pressure (CVP) to ensure adequate preload.
d) The nurse helps the patient with activities until the pain and fever subside.

The nurse helps the patient with activities until the pain and fever subside.

Rationale: Nursing management for acute pericarditis should be aimed at minimizing complications by helping the patient with activities until the pain and fever subside.

A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurses assessment findings is most consistent with myocarditis?

a) Unexplained weight loss
b) Numbness and tingling of the extremities
c) Flulike symptoms
d) Swelling of the joints

Flulike symptoms

Rationale: The clinical manifestations of myocarditis range from mild flulike symptoms, dyspnea, palpitations, and occasionally discomfort to cardiomegaly or heart failure.

The nurse on the hospitals infection control committee is looking into two cases of hospital-acquired infective endocarditis among a specific classification of patients. What classification of patients would be at greatest risk for hospital-acquired endocarditis?

a) Patients receiving parenteral nutrition
b) Postoperative orthopedic patients
c) Patients with indwelling urinary catheters
d) Hemodialysis patients

Hemodialysis patients

Rationale: Hemodialysis patients are at greatest risk for hospital-acquired endocarditis because of the frequent need for vascular access.

The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what?

a) Long-term sequelae of hypertension
b) Congenital heart defects
c) Atherosclerotic changes related to hyperlipidemia
d) Rheumatic heart disease and its sequelae

Rheumatic heart disease and its sequelae

Rationale: Rheumatic heart disease and its sequelae remain the leading cause of mitral valve regurgitation throughout the world.

Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse? Select all that apply.

a) Anxiety
b) Nausea
c) Fatigue
d) Palpitations
e) Productive cough

Anxiety - Rationale: Anxiety is a symptom of mitral valve prolapse.
Fatigue - Rationale: Fatigue is a symptom of mitral valve prolapse.
Palpitations - Rationale: Palpitations is a symptom of mitral valve prolapse.

A cardiac surgery patients new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurses most appropriate action?

a) Administer a bolus of intravenous normal saline.
b) Prepare to assist with pericardiocentesis.
c) Prepare for the insertion of chest tubes.
d) Administer a beta-adrenergic blocker.

Prepare to assist with pericardiocentesis.

Rationale: Manifestations of cardiac tamponade include sudden cessation of previously high mediastinal drainage, jugular venous distention with clear lung sounds, and equalizing arterial pressures. The nurse would prepare to assist with pericardiocentesis in this situation.

The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis?

a) Rales
b) Rhonchi
c) Absent breath sounds
d) Friction rub

Friction rub

Rationale: A friction rub is auscultated with pericarditis. The other findings are associated with other disorders.