Chapter 28

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A nurse is obtaining a history from a new client in the cardiovascu-
lar clinic. When investigating for childhood diseases and disorders
Rheumatic fever
associated with structural heart disease, which finding should the
nurse consider significant?
Which type of graft is used when a heart valve replacement is
Heterograft
made of tissue from an animal heart valve?
The nurse is auscultating the heart of a client diagnosed with mi-
tral valve prolapse. Which is often the first and only manifestation An extra heart sound
of mitral valve prolapse?
During a teaching session, a client who is having a valvuloplasty
tomorrow asks the nurse about the difference between a mechan- "A mechanical valve is thought to be more durable and so requires
ical valve replacement and a tissue valve. What answer from the replacement less often."
nurse is correct?
A nurse and a nursing student are performing a physical as-
sessment of a client with pericarditis. The client has an audible
"The pericardial surfaces lose their lubricating fluid because of
pericardial friction rub on auscultation. When leaving the room,
inflammation and rub against each other."
the student asks the nurse what causes the sound. The nurse's
best response is which of the following?
A client with aortic stenosis is reluctant to have valve replacement
surgery. A nurse is present when the health care provider talks
to the client about a treatment that is less invasive than surgery Balloon percutaneous valvuloplasty
which will likely relieve some of the client's symptoms. What treat-
ment option has been discussed?
A nurse is caring for a client with aortic stenosis whose compen-
satory mechanisms of the heart have begun to fail. The nurse will Exertional dyspnea, orthopnea, pulmonary edema
monitor the client carefully for which initial symptoms?
A nurse is preparing a teaching plan regarding biological tissue
valve replacement. What is a disadvantage of this type of valve The valve has to be replaced frequently.
replacement?
A nurse is assessing a patient who has had valvular heart disease Paroxysmal nocturnal dyspnea
for more than 15 years. Which signs and symptoms should the Orthopnea
nurse expect? (Choose all that apply.) Cough
The diagnosis of aortic regurgitation (AR) is confirmed by which
Echocardiography
of the following?
If a client were to develop rheumatic carditis, which cardiac struc-
mitral valve
ture would most likely be affected?
A total artificial heart (TAH) is an electrically powered pump that
circulates blood into the pulmonary artery and the aorta, thus
An LVAD only supports a failing left ventricle.
replacing the functions of both the right and left ventricles. What
makes it different from an LVAD?
A nurse reviewing a client's echocardiogram report reads the fol-
lowing 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 hypertrophic
the ventricular cavities. Several areas of the myocardium show
evidence of scarring." The nurse knows these manifestations are
indicative of which type of cardiomyopathy?
A client with a myocardial infarction develops acute mitral valve
regurgitation. The nurse knows to assess for which manifestation
Shortness of breath
that would indicate that the client is developing pulmonary con-
gestion?
A client with a recent history of atrial fibrillation has been pre-
scribed warfarin. What action will the nurse take to confirm safe Review the client's international normalized ratio (INR).
dosing?

"You are at risk of developing an infection in your heart."

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 Chapter 28
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A client with a mechanical valve replacement asks the nurse,
"Why do I have to take antibiotics before getting my teeth
cleaned?" What is the nurse's best response?
A nurse is caring for a client receiving warfarin therapy following a
mechanical valve replacement. The client had a prothrombin time
Assess the client for bleeding and notify the health care provider
and International Normalized Ratio (INR) drawn before breakfast.
of the results.
The laboratory report shows the client's INR reading was 4. What
is the nurse's first priority?
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 the high risk for complications if she becomes pregnant while
mentions to the nurse that she relies on the rhythm method for taking warfarin
birth control. What education will be a priority for the nurse to
provide to this client?
The nurse is educating a client about the care related to a new
diagnosis of mitral valve prolapse. What statement made by the "I will avoid caffeine, alcohol, and smoking."
client demonstrates understanding of the teaching?
A nurse is admitting a client with hypertrophic cardiomyopathy
isosorbide dinitrate
(HCM). What medication order will the nurse question?
A client with a forceful, pounding heartbeat is diagnosed with mi-
tral valve prolapse. Which client statement indicates to the nurse "I can still drink coffee and tea."
a need for additional teaching?
The nurse determines that a client recently diagnosed with suba-
"I have to call my doctor so I can get antibiotics before seeing the
cute bacterial endocarditis understands discharge teaching upon
dentist."
which client statement?
A client with a confirmed DVT is being discharged from the
ED. Which client statement indicates that the client has received
"I need to do my leg exercises five times or more every hour."
proper nursing instruction and understands how to manage this
condition?
Which would the nurse stress as a periodic lifelong necessity for
Antibiotic therapy
a client managing infective endocarditis?
A nurse is teaching a client about valve replacement surgery.
"The valve is made from my own heart valve, and I will not need
Which statement by the client indicates an understanding of the
to take any blood-thinning drugs when I am discharged."
benefit of an autograft replacement valve?
A client comes to the clinic reporting fever, chills, and sore throat
and is diagnosed with streptococcal pharyngitis. A nurse knows
Rheumatic fever
that early diagnosis and effective treatment is essential to avoid
which preventable disease?
The nurse obtains a health history from a client with a prosthetic
heart valve and new symptoms of infective endocarditis. Which "Have you been to the dentist recently?"
question by the nurse is most appropriate to ask?
A client is admitted to the hospital with possible acute pericarditis
and pericardial effusion. The nurse knows to prepare the client for Echocardiography
which diagnostic test to confirm the client's diagnosis?
The nurse determines that a patient has a characteristic symptom
of pericarditis. What symptom does the nurse recognize as sig- Constant chest pain
nificant for this diagnosis?
The nurse is caring for a patient diagnosed with pericarditis. What
Cardiac tamponade
serious complication should this patient be monitored for?
A nurse evaluates a client and suspects pericarditis. What indica-
Chest pain
tor is considered the most characteristic symptom of pericarditis?
The nurse suspects a client has developed pericarditis after a
fever, chest discomfort, and elevated erythrocyte sedimentation
week of cold-like symptoms. Which of the client's signs and symp-
rate (ESR)
toms indicate pericarditis?

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 Chapter 28
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A nurse is teaching a client about mitral stenosis. What is the key
increased resistance of a narrowed orifice between the left atrium
teaching point regarding the disruption to the normal flow of blood
and the left ventricle
through the heart due to mitral stenosis?
Which nursing intervention should a nurse perform to reduce
Maintain the client on bed rest
cardiac workload in a client diagnosed with myocarditis?
Which describes a valve used in replacement surgery that is made
Autograft
from the client's own heart valve?
A nurse is caring for a client with acute mitral regurgitation related
to an acute myocardial infarction. The nurse knows to monitor the Severe heart failure
client carefully for symptoms of which initial complication or result?
The nurse understands that which of the following medications will
be administered to the client for 6 to 12 weeks following prosthetic Warfarin
porcine valve surgery?
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 Obtaining a throat culture
following?
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 A client with chest trauma
for an effusion?
A client reporting heart palpitations is diagnosed with atrial fibril-
lation caused by mitral valve prolapse. To relieve the symptoms, Eliminate caffeine and alcohol
the nurse should teach the client which dietary intervention?
A nurse is caring for a client who had an aortic balloon valvulo-
plasty. The nurse should inspect the surgical insertion site closely Bleeding and infection
for which complication(s)?
A client who had a prosthetic valve replacement was taking war-
farin to reduce the risk of postoperative thrombosis. The client
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visited the nurse at a clinic once a week. What INR level would
alert the nurse to notify the health care provider?
A client who suffered blunt chest trauma in a motor vehicle acci-
dent reports chest pain during deep inspiration. On auscultation,
the nurse detects a pericardial friction rub — a classic sign of Leaning forward while sitting
acute pericarditis. To relieve this chest pain, which position should
the nurse encourage the client to assume?
Which mitral valve condition generally produces no symptoms? Prolapse
A client is admitted to the hospital with aortic stenosis. What
assessment findings would indicate the development of left ven- Dyspnea, orthopnea, pulmonary edema
tricular failure?
The instructor is talking with a nursing student who is caring for a
client with pericarditis. The instructor asks the student to name the
Precordial pain
main characteristic of pericarditis. What should be the student's
answer?
A client is diagnosed with rheumatic endocarditis. What bacterium
Group A, beta-hemolytic streptococcus
is the nurse aware causes this inflammatory response?
The nurse is caring for a client who has been diagnosed with aortic
stenosis. The client is prescribed digoxin. What is the rationale for left ventricular dysfunction
the medication?
A nurse is assigned to the medical intensive care unit. The nurse
auscultates a water-hammer pulse. What will the sound resem- quick, sharp strokes that suddenly collapse
ble?
The nurse is providing discharge teaching for a client with
rheumatic endocarditis but no valvular dysfunction. On which Risk for infection
nursing diagnosis should the nurse focus her teaching?
What is the most common cause of mitral stenosis? Rheumatic endocarditis

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 Chapter 28
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A client with mitral stenosis is admitted to the hospital. What
Distended jugular veins, pedal edema, nausea
assessment findings would indicate right ventricular failure?
A nurse is teaching a client who is awaiting a heart transplant.
"I will need to take three different types of medications for the rest
Which statement indicates the client understands what is required
of my life to help prevent rejection."
to help minimize rejection?
A nurse is conducting a health history on a client with a primary
diagnosis of mitral stenosis. Which disorder reported by the client Rheumatic endocarditis
is the most common cause of mitral stenosis?
The medical plan of treatment for chronic mitral regurgitation
Angiotensin-converting enzyme (ACE) inhibitors.
would include medications to reduce afterload, such as:
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 treat-
Left ventricular assist device
ment options available that the health care provider mentioned
earlier. What option will the nurse most likely discuss?
The nurse is preparing to administer warfarin to a client with a me-
chanical valve replacement. The client's international normalized Administer the medication as ordered.
ratio is 2.7. What action will the nurse take?
The nurse completes an assessment of a client admitted with
pericarditis. What client symptom will the nurse correlate with the reports of constant chest pain
diagnosis of pericarditis?
A patient with pericarditis is experiencing cardiac tamponade.
Which collaborative intervention should the nurse anticipate for Prepare for pericardiocentesis.
this patient?
While auscultating the heart of a pediatric client who is recovering
from acute rheumatic fever, the nurse hears a murmur. This sound valve damage.
may indicate:
A client reports headaches and "just not feeling right," which the
client blames on ongoing sleep disturbances. Inspection reveals
infective endocarditis.
Janeway lesions on the bottoms of the client's feet. These symp-
toms may indicate:
The nurse is caring for a client diagnosed with bacterial my-
carvedilol
ocarditis. The client's heart rate is 120-130 beats per minute and
amiodarone
blood pressure 158/89 mm Hg. What medications will the nurse
penicillin
administer to treat the client with myocarditis? Select all that apply.

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