CARDIO_PREP_U MDC 3 CHAPTER 28 EXAM - CARDIOVASCULAR AND HEMATOLOGY. Cardiac Disorders

Chap 28 LEVEL 1 Which describes a valve used in replacement surgery that is made from the client's own heart valve? Autograft Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve? Heterograft An adult client with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. The medical history reveals diabetes mellitus, hypertension, and pernicious anemia. The client underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. What history finding is a major risk factor for infective endocarditis? Hx of aortic valve replacement In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? Hypertrophic During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct? A mechanical valve is thought to be more durable and so requires replacement less often A client with a history of cardiomyopathy experiences dyspnea on exertion, fatigue, leg swelling, and chest pain. This client has which type of cardiomyopathy? Dilated cardiomyopathy Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis? Increased use of prosthetic valve replacements A nurse reviewing a client’s echocardiogram report reads the following statements: “The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scaring.” The nurse knows these manifestations are indicative of which type of cardiomyopathy? HypertrophicA nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client’s level of anxiety has decreased when the client is able to discuss the prognosis freely A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing? Review the client’s international normalized ratio (INR) The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point? The treatments include medications, medical devices, surgery, or transplantation A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. What is considered to be one of the last treatments for end-stage cardiomyopathy? Heart transplantation A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? Rheumatic fever A client comes to the clinic reporting 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 preventable disease? Rheumatic fever What medication order would the nurse question for a patient being treated for pericarditis? indomethacin A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub. What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? The nurse asks the client to hold the breath during auscultation A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client? The high risk for complications if she becomes pregnant while taking warfarinWhich mitral valve condition generally produces no symptoms? Prolapse The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? I have to call my doctor so I can get antibiotics before seeing the dentist The diagnosis of aortic regurgitation (AR) is confirmed by which of the following? Echocardiography A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment? Acute pain A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority? Assess the client for bleeding and notify the health care provider of the results LEVEL 2 Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? Maintain the client on bed rest A client with infective endocarditis is admitted to the hospital. While obtaining a history, what should the nurse ask the client about? Select all that apply. Renal dialysis, IV drug use, nasal piercing, prosthetic cardiac valves, recent UTI If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected? Mitral valve A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? Shortness of breath The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? Extra heart soundWhich action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community? Teach individuals in the community to seek medical treatment for streptococcal pharyngitis The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? Constant chest pain The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? Cardiac tamponade A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned earlier. What option will the nurse most likely discuss? Left ventricular assist device Which valve lies between the right ventricle and the pulmonary artery? Pulmonic valve A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms? Exertional dyspnea, orthopnea, pulmonary edema A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)? bleeding and infection The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching? I will avoid caffeine, alcohol, and smoking LEVEL 3 Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? Shortness of breath A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result? Severe heart failureWhile assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? Ask the patient to lean forward and listen again The nurse understands that which of the following medications will be administered to the client for 6 to 12 weeks following prosthetic porcine valve surgery? Warfarin A nurse is teaching a client about valve replacement surgery. Which statement by the client 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 A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client’s diagnosis? Echocardiography A client with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which assessment data obtained by the nurse should be immediately communicated to the health care provider? Crackles audible throughout the lungs The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? Reports of constant chest pain LEVEL 4 A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? I can still drink coffee and tea What is the most common cause of mitral stenosis? Rheumatic endocarditis The nurse is caring for a client with cardiac compromise related to mitral valve impairment. Which outcome of the eroding of the mitral valve is most significant? Heart failure It is important for a nurse to be aware of the normal hemodynamics of blood flow to recognize and understand pathology when it occurs. The nurse should know that incomplete closure of the tricuspid valve results in a backward flow of blood from the right ventricle to the right atriumThe nurse is caring for a client diagnosed with aortic stenosis prescribed digoxin. What clinical manifestation will be the rationale for the medication? Left ventricle dysfunction The nurse is preparing to administer warfarin to a client with a mechanical valve replacement. The client's international normalized ratio is 2.7. What action will the nurse take? Administer the medication as ordered A nurse is assigned to the medical intensive care unit. The nurse ascultates a water-hammer pulse. What will the sound resemble? Quick, sharp strokes that suddenly collapse A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure? Dyspnea, orthopnea, paroxysmal nocturnal dyspnea The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis? Positive blood culture When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful? I may have to take prophylactic antibiotics for up to 10years An asymptomatic client questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which is the most appropriate response by the nurse? Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? A client 4 days postop after mitral valve replacement The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered? Throat cultureClients with myocarditis are sensitive to which medication? Digoxin A nurse is teaching a client who is awaiting a heart transplant. Which statement indicates the client 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 A client comes into the emergency department reporting 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 diagnosis? Pericarditis A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease? The client with mitral valve prolapse probably had no health symptoms A nurse plans to have an education session with a client who has cardiomyopathy and the client's spouse about ways to decrease the sense of powerlessness. What action by the nurse will provide this information? Assist the client in identifying life areas over which the client still has control A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? Group A betahemolytic streptococcus A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume? Leaning forward while sitting LEVEL 5 Incomplete closure of the mitral valve results in backflow of blood from the: left ventricle to left atrium A client reports headaches and “just not feeling right,” which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate: infective endocarditisThe nurse is instructing a new graduate nurse. Together, they are caring for a client with infective endocarditis. What is a sign of infective endocarditis? Splinter hemorrhage A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection? Cyclosporine A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? Red or purple macules found on the palms of the hands The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? Risk for infection A young mother brings her 4-year-old in to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child’s heart rate is rapid, and the rhythm is abnormal. The mother states the child has been healthy until about 3 weeks ago when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis? Group A beta-hemolytic strep The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, “Where did I pick up these bacteria?” The nurse is most safe to speculate which of the following? From a break in the skin The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder? Aortic regurgitationLEVEL 7 Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. Restrictive cardiomyopathy The nurse is caring for a five-client assignment on a cardiac unit. In caring for which client would the nurse be most correct to assess for an effusion? A client with chest trauma A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention? Eliminate caffeine and alcohol Which intervention should the nurse include in the plan of care for a client with valvular heart disease who is experiencing pulmonary congestion? Rest and sleep in a chair or sit in bed with head elevated A nurse is teaching a client about mitral stenosis and the effect on blood flow in the heart. What is teaching point of the disruption to the normal flow of blood through the heart from the mitral stenosis? Increased resistance of a narrowed orifice between the left atrium and left ventricle LEVEL 8 A client with mitral stenosis is admitted to the hospital. What assessment findings would indicate right ventricular failure? Distended jugular veins, pedal edema, nausea The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client? Placing the patient in the high-fowler’s position with an over-the bedtable for the patient to lean on A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client’s symptoms may indicate: cardiomyopathy A patient has been diagnosed with fused mitral leaflets, causing a backward flow of blood. What type of procedure does the nurse know is commonly performed for this type of problem? CommissurotomyA client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply. Elevated WBC count, elevated C-reactive protein, elevated ESR The nurse completes an assessment of a client with mitral regurgitation. What statement represents the appropriate physical finding for a client with this condition? The high pitched blowing sound at the apex is indicative of a systolic murmur The nurse is assessing a client admitted with acute left-sided infective endocarditis. What is the best diagnostic test to confirm the diagnosis? Blood cultures A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur? Diastolic, rumbling, low-pitched A health care provider admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. What will an assessment by the nurse most likely reveal? Osler’s nodes and splinter hemorrhages A nurse is told in report that a patient has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur? Seconded intercostal space, right sternal notch A client's chart indicates Virchow’s triad. This client is at risk for which complication? Thrombophlebitis A nurse is teaching a client about an upcoming surgery to separate fused cardiac leaflets. Which term is used to describe this surgery? Commissurotomy On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard? Low-pitched, rumbling diastolic murmur at the apex of the heart A client with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings? I anticipated this complication and I will call the health care provider right nowA nurse is caring for a client diagnosed with a mitral valve prolapse who is asymptomatic. What will nurse expect to be ordered for this client? No treatment Which procedure describes splitting or separating fused cardiac valve leaflets? Commissurotomy A client hospitalized for 10 days with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy for 2 to 6 weeks is anticipated. During discharge planning with the client, what is most important for the nurse to review? Assess the client’s home environment in terms of family assistance and adequacy A client with infective endocarditis (IE) and a fever is admitted to the intensive care unit. Which of these physician orders should the nurse implement first? Order blood cultures drawn from two sites The nurse is teaching a school community parent group about heart wellness. What risk factor is a common leading cause for mitral stenosis? Rheumatic fever A nurse is assessing a client with aortic stenosis. What type of murmur will the nurse expect to hear? Loud and rough during systole During auscultation of a client, the nurse suspects a diagnosis of mitral valve regurgitation when hearing which of the following? High-pitched blowing sound at the apex The nurse is caring for a client with manifestations of dilated cardiomyopathy. When planning care, which consideration would the nurse make? Place bed in a high or semi-high fowler’s position as needed Which common assessment question does the nurse use when admitting all clients that helps to screen for cardiomyopathy? Have you ever had a close family member die unexpectedly The nurse is caring for clients on a busy cardiac unit. Following morning assessment, the nurse would notify the physician with which of the following symptoms? Pulsus paradoxus on vital sign assessment A client is admitted with aortic regurgitation. Which medication classification is contraindicated because they can cause bradycardia and decrease ventricular contractility? Calcium channel blockersThe nurse is admitting a client with infective endocarditis (IE). What questions will the nurse ask to explore known risk factors associated with IE? Select all that apply. Do you have a pacemaker insertion, are you injecting any drugs, do you have an tattoos A nurse is preparing home care instructions for a client with infective endocarditis. What will the nurse include in the instructions? Select all that apply. Monitor IV catheter sites for signs of infection, inform all heath care providers of the hx of endocarditis, encourage oral hygiene at least twice daily with a soft toothbrush Which behavior indicates to the nurse that the cardiac client's level of anxiety has increased? Avoids answering questions regarding status Which changes occur to the heart as a result of heart transplant? Heart beats faster than the natural heart The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload? When resting, sit up with the legs down to pool blood in the legs The nurse assessing a patient with pericardial effusion at 0800 notes the apical pulse is 74 and the BP is 140/92. At 1000, the patient has neck vein distention, the apical pulse is 72, and the BP is 108/92. Which action would the nurse implement first? Stay with the patient, use a calm voice, and ask for assistance via call light A nurse is assessing a patient who has had valvular heart disease for more than 15 years. Which signs and symptoms should the nurse expect? (Choose all that apply.) paroxysmal nocturnal dyspnea, orthopnea, cough Which of the following clinical manifestations would the nurse expect to find in the client diagnosed with aortic regurgitation? Visible neck vein pulsations A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? Chronic alcohol abuse Which type of cardiomyopathy is associated with syncope? hypertrophic The nursing instructor is teaching a class on thrombophlebitis. What should the nurse tell the students about the inflammatory response in thrombophlebitis? The inflammatory response is caused by accumulated waste products in the blocked vesselA client with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the client for which manifestations? Anorexia and confusion The nurse is assessing a client admitted with infective endocarditis. Which manifestation would the nurse expect to find? Small painful lesions on the pads of the fingers and toes The nurse suspects a diagnosis of mitral valve regurgitation when what type of murmur is heard on auscultation? High-pitched blowing sound at the apex A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has a new onset of hypertrophic cardiomyopathy (HCM). What will be included on the plan of care? An insertion of an implantable cardiac deibrillator The nurse is discharging a client recently diagnosed with aortic stenosis (AS). What are symptoms associated with aortic stenosis? Angina, syncope, and dyspnea A client with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. What collaborative management will the nurse expect for this client? Surgical valve replacement A client needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education? Im anxious because ill need to have cardiopulmonary bypass The nurse is caring for a client with cardiogenic shock in an critical care unit and the family is asking about the intra-aortic balloon pump (IABP). What will the nurse explain is the premise of using IABP? The IABP is reducing the workload of the heart during the shock period What are the first symptoms of cardiac tamponade? Select all that apply chest tightness, shortness of breath, dizzinessThe nurse is teaching a client about mitral stenosis. What are pathophysiologic events occurring in mitral stenosis? Select all that apply. Pulmonary pressure increases, diastole is shortened, amount of time for forward flow is lessened The nurse is obtaining a history from a client diagnosed with hypertrophic cardiomyopathy. What information obtained from the client is indicative of hypertrophic cardiomyopathy? A parent has the same disorder One of the most common causes of mitral valve regurgitation in people living in developed countries is ischemia of the left ventricle The nurse is caring for a client newly diagnosed with myocarditis. Which diagnostic test would the nurse find most helpful in confirming the diagnosis? Myocardial biopsy A patient has received a heterograft for a tricuspid valve replacement. What statement made by the patient demonstrates understanding of the valve replacement? I will not take long-term anticoagulation because I want to get pregnant A nurse is admitting a client with hypertrophic cardiomyopathy (HCM). What medication order will the nurse question? Isosorbide dinitrate The nurse is caring for a client with aortic regurgitation. What medication will the nurse administer to reduce afterload? Nitroprusside A client was admitted to the hospital with a diagnosis of aortic regurgitation. On assessment, what positive indicators for the disease process will the nurse note? Select all that apply. The presence of a diastolic murmur, visible neck vein pulsations, the pulse has a rapid upstroke, then collapses The nurse is evaluating the expected outcomes following thrombolytic therapy for a right leg deep vein thrombosis. Which of the following findings confirms a positive outcome? Select all that apply. Right extremity comparable in size to left, no bleeding or bruising noted, client denies pain, right extremity pinkA nurse working in the medical intensive care unit has a client admitted with mitral stenosis. The nurse is precepting a graduate nurse and explains the pathophysiology of the condition. What statement made by the graduate nurse will reflect an appropriate understanding of the disease process? Select all that apply. There is a narrowing between the left atrium and left ventricle, increased blood flow in the left atrium causes left atrial hypertrophy The client with which characteristic is considered at high risk for the development of infective endocarditis? Cyanotic congenital malformation The nurse is performing a medication review of a client diagnosed with myocarditis. What medication may have precipated the client to have myocarditis? Azathioprine A nurse is caring for a client who was admitted yesterday with myocarditis. The client takes insulin, digoxin, and metformin at home and continues these medications during hospitalization. During the morning assessment, the client reports anorexia, nausea, vomiting, headache, and disturbed color vision. An ECG strip shows a prolonged PR interval. What should the nurse suspect? Digoxin toxicity A client is diagnosed with mitral regurgitation. What does the nurse consider with the mechanics of cardiac hemodynamics? Blood flows backward from the left ventricle into the left atrium during systole