MEDICAL SURGICAL NURSING CHAPTER 28
QUESTONS AND ANSWERS UPDATED. RATED
A+.
Chapter 28: Management of Patients With Structural, Infectious,
and Inflammatory Cardiac Disorders
1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the
pathophysiology of this disease process, the nurse would expect the patient to exhibit what
heart rhythm?
A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia
ANSWER: C
EXPLANATION:
In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial
fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
2. 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) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations
ANSWER: C
EXPLANATION:
,Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental
procedures involving manipulation of gingival tissue, the periapical area of the teeth or
perforation of the oral mucosa (not including routine anesthetic injections, placement of
orthodontic brackets, or loss of deciduous teeth). There are no current recommendations
around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to
people who are immunosuppressed.
, 3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit.
During the nurses admission interview, the patient states that she takes over-the-counter
water pills on a regular basis. How should the nurse best respond to the fact that the patient
has been taking diuretics?
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patients oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patients fluid balance is monitored vigilantly.
ANSWER: C
EXPLANATION:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be made
aware. Adjusting the patients sodium or fluid intake or fluid monitoring does not address this
important contraindication.
4. 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) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant.
ANSWER: D
EXPLANATION:
After heart transplant, patients are constantly balancing the risk of rejection with the risk of
infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf),
azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to
minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output,
or increase white cell counts.
5. A patient with a history 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) Enoxaparin (Lovenox)
QUESTONS AND ANSWERS UPDATED. RATED
A+.
Chapter 28: Management of Patients With Structural, Infectious,
and Inflammatory Cardiac Disorders
1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the
pathophysiology of this disease process, the nurse would expect the patient to exhibit what
heart rhythm?
A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia
ANSWER: C
EXPLANATION:
In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial
fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
2. 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) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations
ANSWER: C
EXPLANATION:
,Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental
procedures involving manipulation of gingival tissue, the periapical area of the teeth or
perforation of the oral mucosa (not including routine anesthetic injections, placement of
orthodontic brackets, or loss of deciduous teeth). There are no current recommendations
around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to
people who are immunosuppressed.
, 3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit.
During the nurses admission interview, the patient states that she takes over-the-counter
water pills on a regular basis. How should the nurse best respond to the fact that the patient
has been taking diuretics?
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patients oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patients fluid balance is monitored vigilantly.
ANSWER: C
EXPLANATION:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be made
aware. Adjusting the patients sodium or fluid intake or fluid monitoring does not address this
important contraindication.
4. 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) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant.
ANSWER: D
EXPLANATION:
After heart transplant, patients are constantly balancing the risk of rejection with the risk of
infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf),
azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to
minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output,
or increase white cell counts.
5. A patient with a history 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) Enoxaparin (Lovenox)
