Med_Surg_Chapter_28

MED-SURG Chapter 28: Managements of Patients With Structural, Infectious and Inflammatory Cardiac Disorders Question A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following? • Heart transplantation Question The nurse is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination? • Orthopnea and dyspnea Question The diagnosis of aortic regurgitation (AR) is confirmed by which of the following? • Echocardiography Question A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition? • "I need to do my leg exercises five times or more every hour." Question 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 Question A physician admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has: • Osler's nodes and splinter hemorrhages. Question A patient with endocarditis is being discharged home. In evaluating the effectiveness of patient teaching about how to prevent recurrence of the infection, the student nurse would expect the patient to state: I will ask for antibiotics whenever I have dental work done." Question The school nurse is providing care to a child with a sore throat. With any sign of throat infection, the nurse stresses which of the following? • Obtaining a throat culture Question A 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. Question A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider. • 3.8 Question Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? • Check regularly for dependent edema Question The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? • Warfarin Question Which nursing intervention would reduce cardiac workload in a client with myocarditis? • Maintain the client on bed rest. Question A patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder? • Echocardiogram Question A client with a recent history of atrial fibrillation has been prescribed warfarin. When confirming whether the prescribed dose is safe and appropriate for the client, the nurse should: • review the client's international normalized ratio (INR). Question Which describes a valve used in replacement surgery that is made from the client's own heart valve? • Autograft Question The nurse determines that a 49-year-old 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." Question 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 endocarditis. Question The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? • Cardiac tamponade Question When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom? • Chest pain Question 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 Question 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." Question 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 Question 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 Question 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 Question Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve? • Heterograft Question Which valve lies between the right ventricle and the pulmonary artery? • Pulmonic valve Question Which of the following is an inaccurate statement regarding an autograft? • Anticoagulation is necessary. Question Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? • Maintain the client on bed rest. Question A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider. • 3.8 Question Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? • Maintain the client on bed rest Question Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? • Shortness of breath Question A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client’s symptoms may indicate: • cardiomyopathy. Question The nurse otains a health history from a client 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?" Question 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 Question A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume? • Leaning forward while sitting Question Which signs and symptoms accompany a diagnosis of pericarditis? • Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Question A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure? • Dyspnea, orthopnea, pulmonary edema Question A client's chart indicates Virchow’s triad. This client is at risk for which complication? • thrombophlebitis Question 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? • Hypertrophic Question A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following? • Left ventricular assist device Question 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 failure Question A patient with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The graduate nurse discusses this development with the nurse preceptor. The preceptor is assured when the graduate nurse states: • his complication and I will call the doctor right now." Question For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? • Left ventricular dysfunction Question A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? • Group A, beta-hemolytic streptococcus