Deck 23: Nursing Care of Patients With Valvular, Inflammatory, and Infectious Cardiac or Venous Disorders

Question 1

The nurse is teaching a patient about mitral valve prolapse and lifestyle modifications. Which statement made by the patient indicates a need for further teaching?

A)"I should cut coffee out of my diet."
B)"I need to avoid physical activity."
C)"I have been practicing yoga to reduce stress."
D)"I will need to follow a balanced diet."

Answer 1

"I need to avoid physical activity."

Question 2

The nurse is caring for a patient with infective endocarditis (IE). Which statement made by the patient leads the nurse to suspect the cause of the IE?

A)"When I was a child, I had rheumatic fever."
B)"I have not been to the dentist in 8 years."
C)"I had a myocardial infarction last year."
D)"I have to sit in one spot for a long time for my job."

Answer 2

"I have not been to the dentist in 8 years."

Question 3

The nurse is reviewing care for a group of patients. Which patient with a heart valve disorder should the nurse identify as being susceptible to developing the complication of fluid volume excess?

A)A 27-year-old male on atenolol (Tenormin)
B)A 68-year-old female on digoxin (Lanoxin)
C)A 44-year-old male taking amoxicillin (Amoxil)
D)An 18-year-old female taking warfarin (Coumadin)

Answer 3

A 68-year-old female on digoxin (Lanoxin)

Question 4

The nurse is reinforcing teaching for a patient who has had a mechanical valve replacement. What should be included regarding safety during warfarin (Coumadin) therapy?

A)Wear medial alert identification.
B)Use a straight razor when shaving.
C)Keep yearly blood test appointments.
D)Increase intake of green leafy vegetables.

Question 5

The nurse is caring for a patient receiving heparin for thrombophlebitis. The nurse observes the patient has bleeding gums and black tarry stools. Which prescribed medication should the nurse plan to administer?

A)Vitamin K
B)Naloxone (Narcan)
C)Protamine sulfate
D)Flumazenil (Romazicon)

Question 6

The nurse is collecting data on a patient recovering from a hysterectomy who is experiencing left calf tenderness. Data include the following: left calf 17.5 inches; right calf 14 inches; left thigh 32 inches; right thigh 28 inches; shiny, warm, and reddened left leg. Which actions should the nurse recommend for this patient's plan of care?

A)Maintain bedrest.
B)Encourage ambulation daily.
C)Place anti-embolism stocking on left leg.
D)Place anti-embolism stocking on both legs.

Question 7

The nurse is caring for a group of patients. Which patient is at highest risk for developing deep vein thrombosis (DVT)?

A)A cashier
B)A truck driver
C)A nurse
D)A mail carrier

Question 8

The nurse is caring for a patient with pericarditis who develops hypotension, confusion, tachycardia, tachypnea, and jugular venous distension. For which procedure should the nurse prepare the patient?

A)Pericardiocentesis
B)Myectomy
C)Endometrial biopsy
D)Commissurotomy

Question 9

The nurse is caring for a group of patients. Which patient is at highest risk for developing pericarditis?

A)A patient with DVT of the right leg
B)A patient with a history of rheumatic fever
C)A patient with ankylosing spondylitis
D)A patient with renal disease and systemic lupus erythematosus (SLE)

Question 10

The nurse is evaluating care provided to a patient with the nursing diagnosis of activity intolerance because of aortic regurgitation. Which outcome indicates that care has been effective?

A)Stated maintained bedrest to reduce fatigue
B)Engaged in desired daily and social activities
C)Completed activities of daily living with assistance
D)Reported no longer participates in gardening hobby

Question 11

A patient with mitral stenosis is prescribed a preoperative antibiotic. Which patient statement indicates an understanding for taking this medication?

A)"To prevent postoperative pneumonia."
B)"To prevent an increase in body temperature."
C)"To prevent a bacterial infection in the heart."
D)"To prevent infection of the surgical incision."

Question 12

The nurse is caring for a patient who has aortic stenosis. During data collection, which of these manifestations should indicate to the nurse that the patient is experiencing myocardial oxygen deficiency?

A)Angina
B)Sacral edema
C)Jugular vein distention
D)Pericardial friction rub

Question 13

The nurse is reinforcing teaching about dilated cardiomyopathy. Which statement made by the patient indicates a need for further teaching?

A)"My condition could be genetic; I should get my kids tested."
B)"I may have heart failure since I have the dilated type of cardiomyopathy."
C)"I have the more common type of cardiomyopathy."
D)"I will not have to receive treatment, since it is not useful."

Question 14

The nurse is caring for a group of patients on the cardiac unit. Which patient is at highest risk for mitral valve prolapse?

A)A 12-year-old male
B)An 18-year-old female
C)A 25-year-old male
D)A 40-year-old female

Question 15

The nurse is assessing a patient who underwent valve replacement surgery. Which finding should concern the nurse the most?

A)Wet lung sounds
B)Urine output 50 mL/hr
C)Temperature of 99.1°F
D)Chest tube drainage of 100 mL/hr

Question 16

The nurse is caring for a patient who develops a fever and reports right calf pain with a reddened and swollen calf. Which action should the nurse take?

A)Massage the affected calf.
B)Place ice on the affected calf.
C)Place elastic stocking on right leg.
D)Measure bilateral calf circumference daily.

Question 17

The nurse is caring for a patient with aortic regurgitation. Which interventions should the nurse implement?

A)Encourage the patient to perform all activities of daily living at once.
B)Schedule activities with periods of rest.
C)Elevate the head of bed (HOB) to 30 degrees.
D)Apply oxygen at 2 liters/nasal cannula.

Question 18

The nurse is providing discharge teaching for a patient with mitral stenosis. What should the nurse include in this teaching?

A)"The medications you will be taking make your blood thicker, so you are at risk for small clots to form."
B)"It is important that you increase your fluid intake and take iron supplements so that your body can make enough blood for your heart to pump around."
C)"Your blood is rushing through your heart so fast that it may not give your heart enough oxygen and you may have something called angina, or heart pain."
D)"Because of your heart condition, the blood flow through your heart is slower and blood may tend to pool in certain areas, which might allow tiny clots to form."

Question 19

The nurse is monitoring a patient with aortic stenosis and notes crackles in the lungs and a cough. Which complication should the nurse suspect is occurring in this patient?

A)Pneumonia
B)Heart failure
C)Hypertension
D)Rheumatic fever

Question 20

A patient who has aortic stenosis develops severe dyspnea and chest pain. Which action should the nurse take?

A)Obtain vital signs.
B)Give nitroglycerin.
C)Raise the head of the bed.
D)Encourage the patient to sleep.

Question 21

The nurse is monitoring a patient with pericarditis. What health problem is this patient at risk for developing?

A)Emboli begin to form.
B)Pericardial sac fluid increases.
C)Cardiac workload increases by 15%.
D)Cardiac output decreases more than 10%.

Question 22

The licensed practical nurse/licensed vocational nurse (LPN/LVN) is observing the student nurse administer enoxaparin (Lovenox). Which step taken by the student requires correction by the nurse?

A)The student cleans the area with alcohol.
B)The student removes any air bubbles.
C)The student injects the medication into the subcutaneous tissue (SQ).
D)The student asks the patient to verify any allergies.

Question 23

A patient with aortic stenosis experiencing angina and syncope is prescribed 0.25 mg of digoxin (Lanoxin). The nurse has available digoxin, 0.125 mg tablet. How many tablets should the nurse administer to the patient?

Question 24

The nurse is reinforcing teaching provided to a patient with thrombophlebitis. Which diagnostic test should the nurse explain is used to confirm thrombophlebitis?

A)Chest radiograph
B)IV pyelogram
C)Duplex venous scanning
D)Arterial Doppler ultrasonography

Question 25

The nurse is caring for a patient with aortic regurgitation. Which clinical manifestations can the nurse expect to document? (Select all that apply.)

A)Forceful heartbeat more pronounced when laying down
B)Exertional dyspnea
C)Fatigue
D)Corrigan pulse
E)Bloody sputum 6.Petechiae

Question 26

A patient is being admitted to the intensive care unit after cardiac surgery. Which nursing actions should the nurse include in this patient's plan of care? (Select all that apply.)

A)Note any patient shivering.
B)Assess breath sounds every shift.
C)Assist in head-to-toe data collection.
D)Place the patient in a cool environment.
E)Connect the patient to a cardiac monitor.
F)Palpate chest and neck for signs of crepitus.

Question 27

A patient with obstructive hypertrophic cardiomyopathy is being released from the hospital and is to continue treatment with atenolol (Tenormin) and disopyramide (Norpace) at home. Which information should be included in the patient's teaching plan? (Select all that apply.)

A)Eat small meals.
B)Drink fluids to remain hydrated.
C)Plan activities in small amounts.
D)Have one alcoholic drink per day.
E)Participate in sports, such as tennis. 6.Check the pulse daily before taking medications.

Question 28

A postoperative patient suddenly develops dyspnea, tachypnea, restlessness, and chest pain. Which complication should the nurse suspect is occurring in this patient?

A)Pulmonary edema
B)Respiratory arrest
C)Pulmonary embolus
D)Myocardial infarction

Question 29

The nurse is caring for a patient with a DVT who is receiving IV heparin. The nurse should monitor which of these laboratory tests specifically for the effects of the heparin?

A)PT
B)Partial thromboplastin time (PTT)
C)Platelets
D)Bleeding time

Question 30

The nurse is caring for a patient with thrombophlebitis of the left leg. Which interventions should the nurse implement? (Select all that apply.)

A)Administer acetaminophen (Tylenol) as ordered.
B)Apply ice to the affected area.
C)Encourage the patient to wear constricting clothing.
D)Apply compression stockings per order.
E)Elevate the feet above heart level.

Question 31

The nurse caring for patients on the cardiac unit reviews the standards related to DVT prophylaxis. Which approach should the nurse recognize as being the most effective to prevent the development of deep vein thrombosis?

A)Using bilateral thigh-high stockings throughout hospitalization
B)Using low molecular weight heparin given subcutaneously daily
C)Using bilateral leg compression devices while the patient is in bed
D)Using a combination of pharmacological and compression interventions

Question 32

The nurse is reviewing the medical histories for a group of patients. Which patients should receive prophylactic antibiotics to prevent infective IE? (Select all that apply.)

A)A 68-year-old with a history of atrial fibrillation scheduled for a root canal
B)A 55-year-old with a history of angina scheduled for arthroscopic knee surgery
C)A 76-year-old with a history of cardiac valve repair scheduled for a colonoscopy
D)A 71-year-old with a history of IE scheduled for a tooth extraction
E)A 69-year-old with a history of congenital heart disease who is having an abscess drained 6.A 56-year-old with a history of mitral valve prolapse scheduled for routine dental cleaning

Question 33

The nurse is reinforcing discharge teaching to a patient with IE. Which topics will the nurse include in the teaching? (Select all that apply.)

A)Brushing teeth with a soft-bristle toothbrush
B)Avoiding biting nails
C)Avoiding applying ointment to cuts
D)Reporting fever or chills to the HCP
E)Instruction on proper handwashing

Question 34

The nurse is caring for a group of patients. Which patient should the nurse see first?

A)A patient with IE who is receiving IV antibiotic therapy
B)A patient who underwent valve replacement surgery 4 hours ago and reports level 9 pain
C)A patient with aortic regurgitation awaiting an echocardiogram
D)A patient with myocarditis who has a 99.1°F fever

Question 35

The nurse is reviewing the prothrombin time (PT) value for a patient prescribed warfarin (Coumadin). The laboratory's PT range is 9 to 11 seconds. What would be the therapeutic time for the patient? 1.12.5 seconds

A)17 seconds
B)26 seconds
C)30 seconds

Question 36

A healthy postoperative patient who has been on bedrest for 3 days suddenly develops dyspnea, tachypnea, restlessness, and chest pain. The patient says, "I feel as if something is going to happen to me." Which action should the nurse take?

A)Perform a bilateral Homans' test.
B)Give a narcotic for pain as ordered.
C)Notify the health care provider (HCP) immediately.
D)Reassure the patient that everything is fine.

Question 37

A patient with a history of mitral valve replacement surgery is instructed to take prophylactic antibiotics before a scheduled root canal. Which patient statement indicates to the nurse that teaching has been effective?

A)"I know I need to call my doctor if I notice a dry cough."
B)"If I notice any ankle edema, I should lower my salt intake."
C)"If I develop a fever in the next week or so, I need to call my doctor right away."
D)"Endocarditis causes rapid weight gain so I need to weigh myself every day for a full week."

Question 38

The nurse is collecting data from a patient 3 days after a motor vehicle crash in which the patient hit the steering wheel. The data reveal symptoms of pericarditis. Which finding indicates the presence of pericarditis?

A)Pain on expiration
B)Pericardial friction rub
C)Jugular vein distention
D)Crackles in lung bases

Question 39

The nurse is caring for a patient with pericarditis. Which type of medication should the nurse expect to be prescribed for the patient?

A)Beta blocker
B)Antihypertensive
C)Anti-inflammatory
D)Calcium channel blocker

Question 40

The nurse is collecting data from a patient. Which approach should the nurse use to determine the presence of a Homans' sign?

A)Observing the calf and thigh color bilaterally
B)Listening with a Doppler to posterior bilateral tibial pulses
C)Measuring the patient's calf and thigh circumference bilaterally
D)Dorsiflexing the patient's foot sharply and asking if calf pain occurs

Question 41

The nurse is preparing to administer Heparin 5,000 units SQ to a patient to prevent DVT. The available dose is Heparin 2,500 units/mL. How many mL will the nurse administer? Enter the numeral only.

Question 42

The nurse is preparing to administer Vancomycin 2 mg in 250 mL normal saline IVPB to run over 2 hours. At what rate will the nurse set the infusion pump? Enter the numeral only.