Chapter 32: Concepts of Care for Patients
with Cardiac Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a client with infective endocarditis. Which infection control
precautions would the nurse use?
a. Standard Precautions
b. Bleeding Precautions
c. Reverse isolation
d. Contact isolation
ANS: A
The client with infective endocarditis does not pose any specific threat of transmitting
the causative organism. Standard Precautions would be used. Bleeding Precautions,
reverse isolation, or Contact Precautions are not necessary.
DIF: Applying TOP: Integrated Process: Nursing Process: Implementation
KEY: Infection, Standard precautions MSC: Client Needs
Category: Safe and Effective Care Environment: Safety and Infection Control
2. A nurse assesses a client with pericarditis. Which assessment finding would the nurse
expect to find?
a. Heart rate that speeds up and slows down.
b. Friction rub at the left lower sternal border.
c. Presence of a regular gallop rhythm.
d. Coarse crackles in bilateral lung bases.
, ANS: B
The client with pericarditis may present with a pericardial friction rub at the left lower
sternal border. This sound is the result of friction from inflamed pericardial layers
when they rub together. The other assessments are not related.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Inflammatory response, Nursing assessment MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
3. After teaching a client who is recovering from a heart transplant to change positions
slowly, the client asks, “Why is this important?” How would the nurse respond?
a. “Rapid position changes can create shear and friction forces, which can tear
out your internal vascular sutures.”
b. “Your new vascular connections are more sensitive to position changes,
leading to increased intravascular pressure and dizziness.”
c. “Your new heart is not connected to the nervous system and is unable to
respond to decreases in blood pressure caused by position changes.”
d. “While your heart is recovering, blood flow is diverted away from the brain,
increasing the risk for stroke when you stand up.”
ANS: C
Because the new heart is denervated, the baroreceptor and other mechanisms that
compensate for blood pressure drops caused by position changes do not function. This
allows orthostatic hypotension to persist in the postoperative period. The other options
are false statements and do not correctly address the client’s question.
DIF: Understanding TOP: Integrated Process: Nursing Process:
Implementation KEY: Transplant, Health teaching MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
, 4. A nurse is providing discharge teaching to a client recovering from a heart transplant.
Which statement would the nurse include?
a. “Use a soft-bristled toothbrush and avoid flossing.”
b. “Avoid large crowds and people who are sick.”
c. “Change positions slowly to avoid hypotension.”
d. “Check your heart rate before taking the medication.”
ANS: B
Clients who have had heart transplants must take immunosuppressant therapy for the
rest of their lives. The nurse would teach this client to avoid crowds and sick people
to reduce the risk of becoming ill him- or herself. These medications do not place
clients at risk for bleeding, orthostatic hypotension, or changes in heart rate.
Orthostatic hypotension from the denervated heart is generally only a problem in the
immediate postoperative period.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Transplant, Health teaching MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
5. A nurse cares for a client with end-stage heart failure who is awaiting a transplant.
The client appears depressed and states, “I know a transplant is my last chance, but I
don’t want to become a vegetable.” How would the nurse respond?
a. “Would you like to speak with a priest or chaplain?”
b. “I will arrange for a psychiatrist to speak with you.”
c. “Do you want to come off the transplant list?”
d. “Would you like information about advance directives?”
ANS: D
The client is verbalizing a real concern or fear about negative outcomes of the
surgery. This anxiety itself can have a negative effect on the outcome of the surgery
because of sympathetic stimulation. The best action is to allow the client to verbalize
with Cardiac Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a client with infective endocarditis. Which infection control
precautions would the nurse use?
a. Standard Precautions
b. Bleeding Precautions
c. Reverse isolation
d. Contact isolation
ANS: A
The client with infective endocarditis does not pose any specific threat of transmitting
the causative organism. Standard Precautions would be used. Bleeding Precautions,
reverse isolation, or Contact Precautions are not necessary.
DIF: Applying TOP: Integrated Process: Nursing Process: Implementation
KEY: Infection, Standard precautions MSC: Client Needs
Category: Safe and Effective Care Environment: Safety and Infection Control
2. A nurse assesses a client with pericarditis. Which assessment finding would the nurse
expect to find?
a. Heart rate that speeds up and slows down.
b. Friction rub at the left lower sternal border.
c. Presence of a regular gallop rhythm.
d. Coarse crackles in bilateral lung bases.
, ANS: B
The client with pericarditis may present with a pericardial friction rub at the left lower
sternal border. This sound is the result of friction from inflamed pericardial layers
when they rub together. The other assessments are not related.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Inflammatory response, Nursing assessment MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
3. After teaching a client who is recovering from a heart transplant to change positions
slowly, the client asks, “Why is this important?” How would the nurse respond?
a. “Rapid position changes can create shear and friction forces, which can tear
out your internal vascular sutures.”
b. “Your new vascular connections are more sensitive to position changes,
leading to increased intravascular pressure and dizziness.”
c. “Your new heart is not connected to the nervous system and is unable to
respond to decreases in blood pressure caused by position changes.”
d. “While your heart is recovering, blood flow is diverted away from the brain,
increasing the risk for stroke when you stand up.”
ANS: C
Because the new heart is denervated, the baroreceptor and other mechanisms that
compensate for blood pressure drops caused by position changes do not function. This
allows orthostatic hypotension to persist in the postoperative period. The other options
are false statements and do not correctly address the client’s question.
DIF: Understanding TOP: Integrated Process: Nursing Process:
Implementation KEY: Transplant, Health teaching MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
, 4. A nurse is providing discharge teaching to a client recovering from a heart transplant.
Which statement would the nurse include?
a. “Use a soft-bristled toothbrush and avoid flossing.”
b. “Avoid large crowds and people who are sick.”
c. “Change positions slowly to avoid hypotension.”
d. “Check your heart rate before taking the medication.”
ANS: B
Clients who have had heart transplants must take immunosuppressant therapy for the
rest of their lives. The nurse would teach this client to avoid crowds and sick people
to reduce the risk of becoming ill him- or herself. These medications do not place
clients at risk for bleeding, orthostatic hypotension, or changes in heart rate.
Orthostatic hypotension from the denervated heart is generally only a problem in the
immediate postoperative period.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Transplant, Health teaching MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
5. A nurse cares for a client with end-stage heart failure who is awaiting a transplant.
The client appears depressed and states, “I know a transplant is my last chance, but I
don’t want to become a vegetable.” How would the nurse respond?
a. “Would you like to speak with a priest or chaplain?”
b. “I will arrange for a psychiatrist to speak with you.”
c. “Do you want to come off the transplant list?”
d. “Would you like information about advance directives?”
ANS: D
The client is verbalizing a real concern or fear about negative outcomes of the
surgery. This anxiety itself can have a negative effect on the outcome of the surgery
because of sympathetic stimulation. The best action is to allow the client to verbalize
