review question chp28

When teaching a patient with rheumatic carditis and a history of recurrent rheumatic fever, which of the following statements made by the patient indicates that teaching has been successful
“I may have to take prophylactic antibiotics for up to 10 years.”

Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require 10 or more years of
antibiotic coverage (e.g., penicillin G intramuscularly (IM) every 4 weeks, penicillin V orally twice a day (BID), sulfadiazine orally daily, or erythromycin orally BID.

Patients with a history of rheumatic fever are susceptible to
infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work.

Steroids are prescribed to suppress
the inflammatory response and aspirin to control the formation of blood clots around heart valves.

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis
Maintain the patient on bed rest.

The nurse should maintain the patient on bed rest to reduce cardiac workload and promote

Bed rest also helps
decrease myocardial damage and the complications of myocarditis.

The nurse should administer supplemental oxygen to relieve tachycardia that may develop from

If the patient has a fever, the nurse should administer a prescribed
antipyretic along with independent nursing measures such as minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids.

The nurse should elevate the patient’s head to promote
maximal breathing potential.

A patient with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the patient for which of the following manifestations
Anorexia and confusion

Patients with restrictive cardiomyopathy RCM have increased sensitivity to
digoxin, and the nurse must anticipate that low doses will be prescribed and assess for digoxin toxicity.

The most common manifestations of digoxin toxicity are
gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system (CNS) disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision).

A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve
“The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged.”

Autografts (i.e., autologous valves) are obtained by
excising the patient’s own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve.

Anticoagulation is
unnecessary because the valve is the patient’s own tissue and is not thrombogenic.

The autograft is an alternative for
children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.

A nurse reviewing a patient’s echocardiogram report reads the following statements: “The heart muscle is asymmetrically thickened and has an increase in overall size and mass, especially along the septum. The ventricular walls are thickened reducing the size of the ventricular cavities. Several areas of the myocardium have evidence of scaring.” The nurse knows these manifestations are indicative of which type of cardiomyopathy

In hypertrophic cardiomyopathy (HCM), the heart muscle asymmetrically increases in
size and mass, especially along the septum.

hypertrophic cardiomyopathy often affects
nonadjacent areas of the ventricle.

increased thickness of the heart muscle reduces the size of the
ventricular cavities and causes the ventricles to take a longer time to relax after systole.

The coronary arteriole walls are also thickened, which decreases
internal diameter of the arterioles.

narrow arterioles restrict the blood supply to the
myocardium, causing numerous small areas of ischemia and necrosis.

necrotic areas of the myocardium ultimately fibrose and scar, further impeding
ventricular contraction.

HCM had also been called
idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).

RCM is characterized by
diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when
the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

A nurse caring for a patient with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which of the following patient behaviors would indicate to the nurse that the patient’s level of anxiety has decreased
The patient is able to discuss the prognosis freely. As anxiety decreases, patients will be able to discuss prognosis freely, verbalize fears and concerns, and participate in support groups.

A patient with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which of the following manifestations that would indicate that the patient is developing pulmonary congestion
Shortness of breath

Chronic mitral regurgitation is often
asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue and weakness are the most common symptoms. Palpitations, shortness of breath on exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the heart’s apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.

An asymptomatic patient questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which of the following is the most appropriate nursing response
Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop.

Once symptoms of heart failure develop, the patient needs to restrict his or her activity level to minimize

A nurse is teaching a patient who is awaiting a heart transplant. Which of the following statements indicate the patient understands what is required to help minimize rejection
“I will need to take three different types of medications for the rest of my life to help prevent rejection.”

Patients who have had heart transplants are constantly balancing
the risk of rejection with the risk of infection.

Patients who have had heart transplants must adhere to a complex regimen of
diet, medications, activity, follow-up laboratory studies, biopsies of the transplanted heart (to diagnose rejection), and clinic visits.

There are three classes of medications that are prescribed for a transplant patient to help minimize rejection
corticosteroids (e.g., prednisone), calcineurin inhibitors (tacrolimus, cyclosporin), and antiproliferative agents (mycophenolate mofetil [CellCept], azathioprine [Imuran], or sirolimus [Rapamune]).

A nurse is conducting a heath history on a patient with a primary diagnosis of mitral stenosis. Which of the following disorders reported by the patient is the most common cause of mitral stenosis
Rheumatic endocarditis

Mitral stenosis is most often caused by
rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.

The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse
Extra heart sound

Often, the first and only sign of mitral valve prolapse is identified when
a physical examination of the heart reveals an extra heart sound referred to as a mitral click.

Fatigue, dizziness, and syncope are other symptoms of
mitral valve prolapsed.

A nurse is teaching a patient about an upcoming surgery to separate fused cardiac leaflets. Which of the following is the correct term used to describe this surgery

Commissurotomy is the splitting or separating of
fused cardiac valve leaflets.

Annuloplasty is a
repair of a cardiac valve’s outer ring.

Chordoplasty is repair of
the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle.

Valvuloplasty is a repair of
a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.

A patient comes to the clinic with complaints of fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which of the following preventable diseases
Rheumatic fever

Rheumatic fever is a preventable disease. Diagnosing and effectively treating can prevent rheumatic fever and, therefore, rheumatic heart disease
streptococcal pharyngitis

A patient comes into the emergency room complaining about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which of the following diagnoses

The primary symptom of pericarditis is
pain, which is assessed by evaluating the patient in various positions. A

patient comes into the emergency room complaining about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction,The nurse tries to identify whether pain is influenced by
respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexion, extension, or rotation of the spine, including the neck; by movements of shoulders and arms; by coughing; or by swallowing.

Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of
pericarditis from pain of myocardial infarction.

A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions
Eliminate caffeine and alcohol

To minimize symptoms of mitral valve prolapse, the nurse should instruct the patient to
avoid caffeine and alcohol.

The nurse encourages the patient To minimize symptoms of mitral valve prolapse
to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine, and epinephrine, which may produce dysrhythmias and other symptoms.

To minimize symptoms of mitral valve prolapse the nurse also explores
possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms.

Which of the following teaching interventions should the nurse include in the plan of care for a patient with valvular heart disease who is experiencing pulmonary congestion
Teaching patients to rest and sleep in a chair or sit in bed with head elevated

Patients who experience symptoms of pulmonary congestion are advised to
rest and sleep sitting in a chair or bed with the head elevated.

Patients with pulmonary congestion, the nurse educates the patient to
take a daily weight and report gains of 3 pounds in 1 day or 5 pounds in 1 week to the primary provider.

Patients with pulmonary congestion, the nurse may assist the patient with planning
activity and rest periods to achieve an acceptable lifestyle.

A patient is admitted with aortic regurgitation. Which of the following medication classifications are contraindicated since they can cause bradycardia and decrease ventricular contractility
Calcium channel blockers

The calcium channel blockers diltiazem (Cardizem) and verapamil (Calan, Isoptin) are contraindicated for patients with
aortic regurgitation as they decrease ventricular contractility and may cause bradycardia.

A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications
Bleeding and infection

Possible complications of an aortic balloon valvuloplasty include
aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.

The nurse obtains a health history from a patient with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask
Have you been to the dentist recently?

Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a
bacteremia, which rarely lasts more than 15 minutes.

a patient has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator [ICD]), bacteremia can cause
bacterial endocarditis.

The nurse is assessing a patient admitted with infective endocarditis. Which of the following manifestations would the nurse expect to find
Small painful lesions on the pads of the fingers and toes

Primary presenting symptoms of infective endocarditis are
fever and a heart murmur. In addition small, painful nodules (Osler nodes) may be present in pads of fingers or toes.

Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community
Teach individuals of the community to seek medical treatment for streptococcal pharyngitis.

Prevention of acute rheumatic fever is dependent upon effective antibiotic treatment of
streptococcal pharyngitis.

A patient with infective endocarditis (IE) and a fever is admitted to the intensive care unit (ICU). Which of these physician orders should the nurse implement first
Order blood cultures drawn from two sites. Blood cultures (with each set including one aerobic and one anaerobic culture) drawn from different venipuncture sites over a 24-hour period (each set at least 12 hours apart), or every 30 minutes if the patient’s condition is unstable, should be obtained before administration of any antimicrobial agents. It is essential to obtain blood cultures before initiating antibiotic therapy to obtain accurate sensitivity results.

A patient is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the patient for which diagnostic test used to confirm the patient’s diagnosis

chocardiograms are useful in detecting the presence of
pericardial effusions associated with pericarditis.

An echocardiogram may detect
inflammation, pericardial effusion, tamponade, and heart failure.

A patient who has had a recent myocardial infarction develops pericarditis and complains of level 6 (on a scale of 0-10) chest pain with deep breathing. Which of these ordered pro re nata (PRN) medications will be the most appropriate for the nurse to administer
Ibuprofen (Motrin) 800 mg po every 8 hours

Pain associated with pericarditis is caused by
inflammation, thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective.

A patient with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which of the following assessment data obtained by the nurse should be immediately communicated to the health care provider
The patient has crackles audible throughout the lungs.

Acute mitral regurgitation, resulting from a myocardial infarction, usually manifests as
severe congestive heart failure.

Dyspnea, fatigue and weakness are the most common symptoms of
Acute mitral regurgitation. Palpitations, shortness of breath on exertion and cough from pulmonary congestion also occur.

Crackles that are audible throughout the lungs indicate that the patient is experiencing
severe left ventricular failure with pulmonary congestion and need immediate interventions, such as diuretics.

A client has been diagnosed with pericarditis. Which layers of the heart are affected with this illness? a. Between the pericardium and the mediastinum b. Between the pericardium and the myocardium c. Between the myocardium and the mediastinum d. Between …

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