Chapter 24 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
Ans: C
Feedback:
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
Ans: C
Feedback:
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 nurse's admission interview, the patient states that she takes over-the- counter
ìwater pillsî 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 patient's oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patient's fluid balance is monitored vigilantly. Ans: C
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should
be made aware. Adjusting the patient's 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. Ans: D
Feedback:
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) B) Metoprolol (Lopressor) C) Azathioprine (Imuran) D)
Amoxicillin (Amoxil) Ans: D
Feedback:
Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary
prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve
prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high- risk
patients immediately before and sometimes after certain procedures. Amoxicillin is the drug
of choice. None of the other listed drugs is an antibiotic.
6. A patient with pericarditis has just been admitted to the CCU. The nurse planning the
patient's care should prioritize what nursing diagnosis?
A) Anxiety related to pericarditis
B) Acute pain related to pericarditis
C) Ineffective tissue perfusion related to pericarditis D) Ineffective breathing pattern
related to pericarditis Ans: B
Feedback:
The most characteristic symptom of pericarditis is chest pain, although pain also may
, be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The
pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration
and when lying down or turning. Anxiety is highly plausible and should be addressed, but
chest pain is a nearly certain accompaniment to the disease. Breathing and tissue perfusion
are likely to be at risk, but pain is certain, especially in the early stages of treatment.
7. A patient newly admitted to the telemetry unit is experiencing progressive fatigue,
hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are
attributable to pulmonary venous hypertension. What valvular disorder should the nurse
anticipate being diagnosed in this patient?
A) Aortic regurgitation
B) Mitral stenosis
C) Mitral valve prolapse
D) Aortic stenosis
Ans: B
Feedback:
The first symptom of mitral stenosis is often dyspnea on exertion as a result of
pulmonary venous hypertension. Symptoms usually develop after the valve opening is
reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue
as a result of low cardiac output. The enlarged left atrium may create pressure on the left
bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e.,
hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and
repeated respiratory infections. Pulmonary venous hypertension is not typically caused by
aortic regurgitation, mitral valve prolapse, or aortic stenosis.
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
Ans: C
Feedback:
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
Ans: C
Feedback:
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 nurse's admission interview, the patient states that she takes over-the- counter
ìwater pillsî 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 patient's oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patient's fluid balance is monitored vigilantly. Ans: C
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should
be made aware. Adjusting the patient's 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. Ans: D
Feedback:
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) B) Metoprolol (Lopressor) C) Azathioprine (Imuran) D)
Amoxicillin (Amoxil) Ans: D
Feedback:
Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary
prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve
prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high- risk
patients immediately before and sometimes after certain procedures. Amoxicillin is the drug
of choice. None of the other listed drugs is an antibiotic.
6. A patient with pericarditis has just been admitted to the CCU. The nurse planning the
patient's care should prioritize what nursing diagnosis?
A) Anxiety related to pericarditis
B) Acute pain related to pericarditis
C) Ineffective tissue perfusion related to pericarditis D) Ineffective breathing pattern
related to pericarditis Ans: B
Feedback:
The most characteristic symptom of pericarditis is chest pain, although pain also may
, be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The
pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration
and when lying down or turning. Anxiety is highly plausible and should be addressed, but
chest pain is a nearly certain accompaniment to the disease. Breathing and tissue perfusion
are likely to be at risk, but pain is certain, especially in the early stages of treatment.
7. A patient newly admitted to the telemetry unit is experiencing progressive fatigue,
hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are
attributable to pulmonary venous hypertension. What valvular disorder should the nurse
anticipate being diagnosed in this patient?
A) Aortic regurgitation
B) Mitral stenosis
C) Mitral valve prolapse
D) Aortic stenosis
Ans: B
Feedback:
The first symptom of mitral stenosis is often dyspnea on exertion as a result of
pulmonary venous hypertension. Symptoms usually develop after the valve opening is
reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue
as a result of low cardiac output. The enlarged left atrium may create pressure on the left
bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e.,
hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and
repeated respiratory infections. Pulmonary venous hypertension is not typically caused by
aortic regurgitation, mitral valve prolapse, or aortic stenosis.
