Deck 37: Nursing Management: Inflammatory and Structural Heart Disorders

Question 1

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

A) "Are you using any illegal IV drugs?"
B) "Do you have any family history of congenital heart disease?"
C) "Can you recall having any chest injuries in the last few weeks?"
D) "Have you had a recent sore throat?"

Answer 1

"Have you had a recent sore throat?"

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?

A) Blood pressure (BP) of 166/96
B) Jugular vein distension (JVD) to the level of the jaw
C) Pulsus paradoxus 8 mm Hg
D) Level 6/10 chest pain with deep inspiration

Answer 2

Jugular vein distension (JVD) to the level of the jaw

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

A) mechanical mitral valves require replacement about every 10 years.
B) no antibiotic prophylaxis to prevent endocarditis is needed after valve repair.
C) biologic replacement valves require the use of life-long immunosuppressive drugs.
D) long-term anticoagulation is necessary after mechanical valve replacement.

Answer 3

long-term anticoagulation is necessary after mechanical valve replacement.

Question 4

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

A) subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).
B) auscultate for a pericardial friction rub that increases in volume during inspiration.
C) note when Korotkoff sounds are audible during both inspiration and expiration.
D) check the ECG for variations in rate in relation to inspiration and expiration.

Question 5

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

A) activity intolerance related to fatigue and arthralgia.
B) risk for infection related to open skin lesions.
C) risk for impaired skin integrity related to pruritus.
D) impaired physical mobility related to permanent joint fixation.

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,

A) "I will need to have monthly antibiotic injections for at 5 years or longer."
B) "I will call the doctor if I develop excessive fatigue or difficulty breathing."
C) "I will need to let my dentist know that I have had this rheumatic fever."
D) "I will be immune to further episodes of rheumatic fever after this infection."

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

A) after 2 weeks of IV antibiotic therapy, the patient may be discharged with oral antibiotics to take for another 4 weeks.
B) hospitalization for 4 to 6 weeks will be necessary to prevent a relapse while receiving IV antibiotic therapy.
C) the patient will be able to receive outpatient IV antibiotic therapy if complications such as heart failure do not develop.
D) hospitalization for IV antibiotics is necessary until the fever is resolved, but then the patient can be discharged on oral antibiotics.

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

A) septicemia.
B) acute pyelonephritis.
C) vegetative embolization.
D) 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

A) multiple ECGs.
B) daily blood cultures.
C) cardiac catheterization.
D) pericardiocentesis.

Question 10

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

A) angina and syncope.
B) dyspnea and hemoptysis.
C) JVD and peripheral edema.
D) hypotension and paroxysmal nocturnal dyspnea (PND).

Question 11

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

A) substernal chest pain and pressure.
B) splinter hemorrhages of the lips.
C) dyspnea and a dry, hacking cough.
D) a new regurgitant murmur.

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

A) force fluids to 3000 ml/day to decrease fever and inflammation.
B) teach the patient to take deep, slow respirations to control the pain.
C) position the patient in Fowler's position, leaning forward on the overbed table.
D) remind the patient to ask for the opioid pain medication every four hours.

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?

A) "Do you have a history of a heart attack?"
B) "Have you any recent immunizations?"
C) "Have you been to the dentist lately?"
D) "Is there a family history of endocarditis?"

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

A) take 1 aspirin a day to prevent embolization from the valve.
B) limit physical activity to avoid stressing the heart valves.
C) schedule an appointment with the doctor every 6 months.
D) discuss the diagnosis of mitral valve prolapse with the dentist.

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

A) petechiae of the buccal mucosa and conjunctiva.
B) fever, chills, and diaphoresis.
C) urine output less than 30 ml/hr.
D) an increase in pulse rate of 15 beats/min with activity.

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

A) obtaining the blood cultures.
B) initiating the IV antibiotic.
C) scheduling the ECG.
D) administering the ASA.

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?

A) A loud systolic murmur is audible along the right sternal border.
B) The patient complains of chest pain associated with ambulation.
C) The point of maximum impulse (PMI) is at the left midclavicular line.
D) A thrill is palpable at the 2nd intercostal space, right sternal border.

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

A) promote rest to decrease myocardial oxygen demand.
B) teach the patient to use sublingual nitroglycerin for chest pain.
C) educate the patient about the need for anticoagulant therapy.
D) elevate the head of the bed 40 degrees to decrease venous return.

Question 19

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

A) place the diaphragm of the stethoscope at the lower left sternal border of the chest.
B) ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.
C) use the diaphragm of the stethoscope to listen for a rumbling, low-pitched, systolic sound.
D) feel the precordial area with the palm of the hand to detect vibration with cardiac contraction.

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

A) teaching people to seek medical diagnosis and treatment for streptococcal pharyngitis.
B) providing prophylactic antibiotics to people with a family history of rheumatic fever.
C) immunizing susceptible groups of people with streptococcal vaccine.
D) promoting hygienic measures to prevent the transmission of streptococcal infections.

Question 21

Which information obtained by the nurse when assessing a patient admitted with mitral valve stenosis should be communicated to the health care provider immediately?

A) The patient has a loud diastolic murmur all across the precordium.
B) The patient has crackles audible to the lung apices.
C) The patient has a palpable thrill felt over the left anterior chest.
D) The patient has 4+ peripheral edema in both legs.

Question 22

A patient who has had recent cardiac surgery develops pericarditis and complains of severe chest pain with deep breathing. Which of these ordered PRN medications should the nurse administer?

A) Oral acetaminophen (Tylenol) 650 mg
B) Oral ibuprofen (Motrin) 800 mg
C) IV morphine sulfate 6 mg
D) Fentanyl 2 mg IV

Question 23

The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC); which information obtained by the nurse is most relevant?

A) The patient reports using cocaine once at age 16.
B) The patient has a history of a recent upper respiratory infection.
C) The patient's 29-year-old brother has had a sudden cardiac arrest.
D) The patient has a family history of coronary artery disease (CAD).

Question 24

A few days after an acute MI, a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first?

A) Notify the patient's health care provider.
B) Auscultate the heart sounds.
C) Check the patient's oral temperature.
D) Give the ordered acetaminophen (Tylenol).

Question 25

A patient who has developed acute pulmonary edema is hospitalized and diagnosed with dilated cardiomyopathy. Which information will the nurse plan to include when teaching the patient about management of this disorder?

A) Careful compliance with diet and medications will control the patient's symptoms.
B) Notify the doctor about any symptoms of heart failure such as shortness of breath.
C) No more than one or two alcoholic drinks daily are permitted.
D) Elevating the legs above the heart will help relieve angina.

Question 26

When caring for the patient with infective endocarditis of the tricuspid valve, the nurse will plan to monitor the patient for

A) flank pain.
B) hemiparesis.
C) dyspnea.
D) splenomegaly.

Question 27

During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding

A) the need to avoid high-voltage electrical fields.
B) how to monitor anticoagulation therapy.
C) the need for valve replacement in 7 to 10 years.
D) how to check the radial pulse.

Question 28

Heparin is prescribed for a patient who has dilated cardiomyopathy has been admitted to the hospital with fatigue and orthopnea. Which statement is appropriate for the nurse to use in patient teaching about anticoagulation therapy?

A) "Heparin will help prevent blood clots from forming in your heart chambers."
B) "Heparin is used to improve the circulation to the muscles in your arms and legs."
C) "Heparin has been prescribed to stop blood clots from traveling to your lungs."
D) "Heparin makes it easier for your heart to pump and will decrease your symptoms."