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?
Ventricular fibrillation (VF)
Ventricular tachycardia (VT)
Atrial fibrillation
Sinus bradycardia
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?
Exposure to immunocompromised individuals
Future hospital admissions
Dental procedures
Live vaccinations
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 water pills on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics?
Encourage the patient to drink at least 2 liters of fluid daily.
Increase the patient’s oral sodium intake.
Inform the care provider because diuretics are contraindicated.
Ensure that the patient’s fluid balance is monitored vigilantly.
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?
Azathioprine decreases the risk of thrombus formation.
Azathioprine ensures adequate cardiac output.
Azathioprine increases the number of white blood cells.
Azathioprine minimizes rejection of the transplant.
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?
Enoxaparin (Lovenox)
Metoprolol (Lopressor)
Azathioprine (Imuran)
Amoxicillin (Amoxil)
A patient with pericarditis has just been admitted to the CCU. The nurse planning the patient’s care should prioritize what nursing diagnosis?
Anxiety related to pericarditis
Acute pain related to pericarditis
Ineffective tissue perfusion related to pericarditis
Ineffective breathing pattern related to pericarditis
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?
Aortic regurgitation
Mitral stenosis
Mitral valve prolapse
Aortic stenosis
The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite?
The procedure can be performed on an outpatient basis in a physician’s office.
Repaired valves tend to function longer than replaced valves.
The procedure is not associated with a risk for infection.
Lower doses of antirejection drugs are required than with valve replacement.
The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM?
Dilated ventricles with atrophy of the ventricles
Dilated ventricles without hypertrophy of the ventricles
Dilation and hypertrophy of all four heart chambers
Dilation of the atria and hypertrophy of the ventricles
A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physician’s choice of antibiotics would be primarily based on what diagnostic test?
Echocardiography
Blood cultures
Cardiac aspiration
Complete blood count
A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease?
Recognizing and promptly treating streptococcal infections
Prophylactic use of calcium channel blockers in high-risk populations
Adhering closely to the recommended child immunization schedule
Smoking cessation
A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this?
To prevent bacterial endocarditis
To prevent hospital-acquired pneumonia
To minimize the need for antibiotic use during the procedure
To decrease the need for surgical asepsis
The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patient’s ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy?
Cardiac catheterization
Arterial blood gases
Echocardiogram
Exercise stress test
The nurse is preparing a patient for cardiac surgery. During the procedure, the patient’s heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?
Orthotopic transplant
Xenograft
Heterotropic transplant
Homograft
A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurse’s interview is most suggestive of this valvular disorder?
I get chest pain from time to time, but it usually resolves when I rest.
Sometimes when I’m resting, I can feel my heart skip a beat.
Whenever I do any form of exercise I get terribly short of breath.
My feet and ankles have gotten terribly puffy the last few weeks.
The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following?
Use of patient-controlled analgesia
Long-term anticoagulant therapy
Steroid therapy
Use of IV diuretics
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what?
Cardiac tamponade
Left ventricular hypertrophy
Right-sided heart failure
Ventricular insufficiency
The nurse is creating a plan of care for a patient with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this patient?
Absence of complications
Adherence to the self-care program
Improved cardiac output
Increased activity tolerance
An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patient’s echocardiogram?
Blood to flow back from the aorta to the left ventricle
Obstruction of blood flow from the left ventricle
Blood to flow back from the left atrium to the left ventricle
Obstruction of blood from the left atrium to left ventricle
A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following?
The need for regularly scheduled testing of the patient’s International Normalized Ratio (INR)
The need to learn to sleep in a semi-Fowler’s position for the first 6 to 8 weeks to prevent emboli
The need to avoid foods that contain vitamin K
The need to take enteric-coated ASA on a daily basis
A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge?
The need for long-term antibiotics
The need for 7 to 10 days of bed rest
Strategies for preventing atherosclerosis
Strategies for infection prevention
A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patient’s symptoms, the nurse should teach the patient to do which of the following?
Eat a high-protein, low-carbohydrate diet.
Avoid activities that cause an increased heart rate.
Avoid large crowds and public events.
Perform deep breathing and coughing exercises.
A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patient’s most recent laboratory results, the nurse should prioritize assessment of which of the following?
Sodium
AST, ALT, and bilirubin
White blood cell differential
BUN
A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse?
Arrange for an alternative bed.
Measure the degree of the curvature.
Notify the surgeon immediately.
Note the scoliosis on the intake assessment.
A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient?
Patients generally stay in the hospital for 6 to 8 days.
Patients are kept in the hospital until they are independent with all aspects of their care.
Patients need to stay in the hospital until they regain normal heart function for their age.
Patients usually remain at the hospital for 24 to 48 hours.
A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty?
For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.
Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well.
Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay.
It’s prudent to get a second opinion before deciding to have valvuloplasty.
* The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should know that complications following this procedure include what? Select all that apply.
Emboli
Mitral valve damage
Ventricular dysrhythmia
Atrial-septal defect
Plaque formation
The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patient’s diagnosis?
Mitral valve regurgitation
Mitral valve stenosis
The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding?
Decreased ejection fraction
Decreased heart rate
Ventricular hypertrophy
A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy?
Dilated cardiomyopathy (DCM).
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Hypertrophic cardiomyopathy (HCM)
Restrictive or constrictive cardiomyopathy (RCM)
The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?
To eat a small meal before taking nitroglycerin
To drink a glass of milk before taking nitroglycerin
To engage in 15 minutes of light exercise before taking nitroglycerin
To rest and relax before taking nitroglycerin
A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment?
Heart transplantation
Balloon valvuloplasty
Stent placement
A patient has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus. In light of this patient’s medication regimen, what nursing diagnosis should be prioritized?
Risk for injury
Risk for infection
Risk for peripheral neurovascular dysfunction
Risk for unstable blood glucose
The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications?
The nurse keeps the patient isolated to prevent nosocomial infections.
The nurse encourages coughing and deep breathing.
The nurse helps the patient with activities until the pain and fever subside.
The nurse encourages increased fluid intake until the infection resolves.
A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurse’s assessment findings is most consistent with myocarditis?
Sudden changes in level of consciousness (LOC)
Peripheral edema and pulmonary edema
Pleuritic chest pain
Flulike symptoms
The nurse on the hospital’s infection control committee is looking into two cases of hospital-acquired infective endocarditis among a specific classification of patients. What classification of patients would be at greatest risk for hospital-acquired endocarditis?
Hemodialysis patients
Patients on immunoglobulins
Patients who undergo intermittent urinary catheterization
Children under the age of 12
The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what?
A decrease in gamma globulins
An insect bite
Rheumatic heart disease and its sequelae
Sepsis and its sequelae
Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse? Select all that apply.
Anxiety
Fatigue
Shoulder pain
Tachypnea
Palpitations
A cardiac surgery patient’s new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse’s most appropriate action?
Prepare to assist with pericardiocentesis.
Reposition the patient into a prone position.
Administer a dose of metoprolol.
Administer a bolus of normal saline.
The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis?
Wheezes
Friction rub
Fine crackles
Coarse crackles
