Brunner Ch 28: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

Question 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

Answer 1

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.

Question 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

Answer 2

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.

Question 3

A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurses 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?
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patients oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patients fluid balance is monitored vigilantly.

Answer 3

Ans: C
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware. Adjusting the patients sodium or fluid intake or fluid monitoring does not address this important contraindication.

Question 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.

Answer 4

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.

Question 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)

Answer 5

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.

Question 6

A patient with pericarditis has just been admitted to the CCU. The nurse planning the patients 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

Answer 6

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.

Question 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

Answer 7

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.

Question 8

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?
A. The procedure can be performed on an outpatient basis in a physicians office.
B. Repaired valves tend to function longer than replaced valves.
C. The procedure is not associated with a risk for infection.
D. Lower doses of antirejection drugs are required than with valve replacement.

Answer 8

ANS: B
Feedback:
In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation. Valvuloplasty carries a risk of infection, like all surgical procedures, and it is not performed in a physicians office. Antirejection drugs are unnecessary because foreign tissue is not introduced.

Question 9

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?
A. Dilated ventricles with atrophy of the ventricles
B. Dilated ventricles without hypertrophy of the ventricles
C. Dilation and hypertrophy of all four heart chambers
D. Dilation of the atria and hypertrophy of the ventricles

Answer 9

Ans: B
Feedback:
DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.

Question 10

A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physicians choice of antibiotics would be primarily based on what diagnostic test?
A) Echocardiography
B) Blood cultures
C) Cardiac aspiration
D) Complete blood count

Answer 10

Ans: B
Feedback:
To help determine the causative organisms and the most effective antibiotic treatment for the patient, blood cultures are taken. A CBC can help establish the degree and stage of infection, but not the causative microorganism. Echocardiography cannot indicate the microorganisms causing the infection. Cardiac aspiration is not a diagnostic test.

Question 11

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?
A) Recognizing and promptly treating streptococcal infections
B) Prophylactic use of calcium channel blockers in high-risk populations
C) Adhering closely to the recommended child immunization schedule
D) Smoking cessation

Answer 11

Ans: A
Feedback:
Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.

Question 12

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?
A) To prevent bacterial endocarditis
B) To prevent hospital-acquired pneumonia
C) To minimize the need for antibiotic use during the procedure
D) To decrease the need for surgical asepsis

Answer 12

Ans: A
Feedback:
Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to decrease the need for surgical asepsis.

Question 13

The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patients ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy?
A) Cardiac catheterization
B) Arterial blood gases
C) Echocardiogram
D) Exercise stress test

Answer 13

Ans: C
Feedback:
The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. The ECG is also important, and can demonstrate dysrhythmias and changes consistent with left ventricular hypertrophy. Cardiac catheterization specifically addresses coronary artery function and arterial blood gases evaluate gas exchange and acid balance. Stress testing is not normally used to differentiate cardiomyopathy from other cardiac pathologies.

Question 14

The nurse is preparing a patient for cardiac surgery. During the procedure, the patients heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?
A) Orthotopic transplant
B) Xenograft
C) Heterotropic transplant
D) Homograft

Answer 14

Ans: A
Feedback:
Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipients heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipients heart, leaving a portion of the recipients atria (with the vena cava and pulmonary veins) in place. Homografts, or allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not terms used to describe heart transplantation.

Question 15

A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurses interview is most suggestive of this valvular disorder?
A) I get chest pain from time to time, but it usually resolves when I rest.
B) Sometimes when Im resting, I can feel my heart skip a beat.
C) Whenever I do any form of exercise I get terribly short of breath.
D) My feet and ankles have gotten terribly puffy the last few weeks.

Answer 15

Ans: C
Feedback:
The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some patients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.

Question 16

The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following?
A) Use of patient-controlled analgesia
B) Long-term anticoagulant therapy
C) Steroid therapy
D) Use of IV diuretics

Answer 16

Ans: B
Feedback:
Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and patient-controlled analgesia may or may be not be used in the immediate postoperative period.

Question 17

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?
A) Cardiac tamponade
B) Left ventricular hypertrophy
C) Right-sided heart failure
D) Ventricular insufficiency

Answer 17

Ans: B
Feedback:
Aortic regurgitation eventually causes left ventricular hypertrophy. In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood. Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.

Question 18

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?
A) Absence of complications
B) Adherence to the self-care program
C) Improved cardiac output 
D) Increased activity tolerance

Answer 18

ANS: C
Feedback:
The priority nursing diagnosis of a patient with cardiomyopathy would include improved or maintained cardiac output. Regardless of the category and cause, cardiomyopathy may lead to severe heart failure, lethal dysrhythmias, and death. The pathophysiology of all cardiomyopathies is a series of progressive events that culminate in impaired cardiac output. Absence of complications, adherence to the self-care program, and increased activity tolerance should be included in the care plan, but they do not have the priority of improved cardiac output.

Question 19

An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patients echocardiogram?
A. Blood to flow back from the aorta to the left ventricle
B. Obstruction of blood flow from the left ventricle
C. Blood to flow back from the left atrium to the left ventricle
D. Obstruction of blood from the left atrium to left ventricle

Answer 19

ANS: A
Feedback:
Aortic regurgitation occurs when the aortic valve does not completely close, and blood flows back to the left ventricle from the aorta during diastole. Aortic regurgitation does not cause obstruction of blood flow from the left ventricle, blood to flow back from the left atrium to the left ventricle, or obstruction of blood from the left atrium to left ventricle.

Question 20

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?
A. The need for regularly scheduled testing of the patients International Normalized Ratio (INR)
B. The need to learn to sleep in a semi-Fowlers position for the first 6 to 8 weeks to prevent emboli
C. The need to avoid foods that contain vitamin K
D. The need to take enteric-coated ASA on a daily basis

Answer 20

Ans: A
Feedback:
Patients who take warfarin (Coumadin) after valve replacement have individualized target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement. Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping upright is unnecessary.

Question 21

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?
A) The need for long-term antibiotics
B) The need for 7 to 10 days of bed rest
C) Strategies for preventing atherosclerosis
D) Strategies for infection prevention

Answer 21

Ans: D
Feedback:
Patients with a mechanical valve prosthesis (including annuloplasty rings and other prosthetic materials used in valvuloplasty) require education to prevent infective endocarditis. Despite these infections risks, antibiotics are not used long term. Activity management is important, but extended bed rest is unnecessary. Valve replacement does not create a heightened risk for atherosclerosis.

Question 22

A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patients symptoms, the nurse should teach the patient to do which of the following?
A) Eat a high-protein, low-carbohydrate diet.
B) Avoid activities that cause an increased heart rate.
C) Avoid large crowds and public events.
D) Perform deep breathing and coughing exercises.

Answer 22

Ans: B
Feedback:
Patients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.

Question 23

A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patients most recent laboratory results, the nurse should prioritize assessment of which of the following?
A) Sodium
B) AST, ALT, and bilirubin
C) White blood cell differential
D) BUN

Answer 23

Ans: A
Feedback:
Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels. Consequently, sodium levels are followed more closely than other important laboratory values, including BUN, leukocytes, and liver function tests.

Question 24

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?
A) Arrange for an alternative bed.
B) Measure the degree of the curvature.
C) Notify the surgeon immediately.
D) Note the scoliosis on the intake assessment.

Answer 24

Ans: C
Feedback:
Most often used for mitral and aortic valve stenosis, balloon valvuloplasty is contraindicated for patients with left atrial or ventricular thrombus, severe aortic root dilation, significant mitral valve regurgitation, thoracolumbar scoliosis, rotation of the great vessels, and other cardiac conditions that require open heart surgery. Therefore notifying the physician would be the priority over further physical assessment. An alternative bed would be unnecessary and documentation is not a sufficient response.

Question 25

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?
A) Patients generally stay in the hospital for 6 to 8 days.
B) Patients are kept in the hospital until they are independent with all aspects of their care.
C) Patients need to stay in the hospital until they regain normal heart function for their age.
D) Patients usually remain at the hospital for 24 to 48 hours.

Answer 25

Ans: D
Feedback:
After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.

Question 26

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?
A) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.
B) Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well.
C) Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay.
D) Its prudent to get a second opinion before deciding to have valvuloplasty.

Answer 26

Ans: A
Feedback:
Some valvuloplasty procedures do not require general anesthesia or cardiopulmonary bypass and can be performed in a cardiac catheterization laboratory or hybrid room. Open heart surgery is not required and the procedure does not carry exceptional risks that would designate it as being dangerous. Normally there is no need for the nurse to advocate for a second opinion.

Question 27

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.
A) Emboli
B) Mitral valve damage
C) Ventricular dysrhythmia
D) Atrial-septal defect
E) Plaque formation

Answer 27

Ans: A, B, C
Feedback:
Possible complications include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, and bleeding from the catheter insertion sites. Atrial-septal defect and plaque formation are not complications of a balloon valvuloplasty.

Question 28

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 patients diagnosis?
A) Mitral valve regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Mitral valve stenosis

Answer 28

Ans: D
Feedback:
Because no valve protects the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails. None of the other listed valvular disorders has this pathophysiological effect.

Question 29

The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding?
A) Decreased ejection fraction
B. Decreased heart rate 
C. Ventricular hypertrophy 
D. Mitral valve regurgitation

Answer 29

ANS: A
Feedback:
DCM is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in patients with DCM.

Question 30

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?
A. Dilated cardiomyopathy (DCM).
B. Arrhythmogenic right ventricular cardiomyopathy (ARVC)
C. Hypertrophic cardiomyopathy (HCM)
D. Restrictive or constrictive cardiomyopathy (RCM)

Answer 30

ANS: C
Feedback:
With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.

Question 31

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?
A. To eat a small meal before taking nitroglycerin
B. To drink a glass of milk before taking nitroglycerin
C. To engage in 15 minutes of light exercise before taking nitroglycerin
D. To rest and relax before taking nitroglycerin

Answer 31

Ans: D
Feedback:
The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.

Question 32

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?
A) Heart transplantation
B) Balloon valvuloplasty
C) Cardiac catheterization
D) Stent placement

Answer 32

Ans: A
Feedback:
When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Valvuloplasty, stent placement, and cardiac catheterization will not address the pathophysiology of cardiomyopathy.

Question 33

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 patients medication regimen, what nursing diagnosis should be prioritized?
A) Risk for injury
B) Risk for infection
C) Risk for peripheral neurovascular dysfunction
D) Risk for unstable blood glucose

Answer 33

Ans: B
Feedback:
Immunosuppressants decrease the bodys ability to resist infections, and a satisfactory balance must be achieved between suppressing rejection and avoiding infection. These drugs do not create a heightened risk of injury, neurovascular dysfunction, or unstable blood glucose levels.

Question 34

The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications?
A) The nurse keeps the patient isolated to prevent nosocomial infections.
B) The nurse encourages coughing and deep breathing.
C) The nurse helps the patient with activities until the pain and fever subside.
D) The nurse encourages increased fluid intake until the infection resolves.

Answer 34

Ans: C
Feedback:
To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patients condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated. Due to pain, coughing and deep breathing are not normally encouraged. An increase in fluid intake is not always necessary.

Question 35

A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurses assessment findings is most consistent with myocarditis?
A) Sudden changes in level of consciousness (LOC)
B) Peripheral edema and pulmonary edema
C) Pleuritic chest pain
D) Flulike symptoms

Answer 35

Ans: D
Feedback:
The most common symptoms of myocarditis are flulike. Chest pain, edema, and changes in LOC are not characteristic of myocarditis.

Question 36

The nurse on the hospitals 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?
A) Hemodialysis patients
B) Patients on immunoglobulins
C) Patients who undergo intermittent urinary catheterization
D) Children under the age of 12

Answer 36

Ans: A
Feedback:
Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis. Patients on immunoglobulins, those who need in and out catheterization, and children are not at increased risk for nosocomial infective endocarditis.

Question 37

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) A decrease in gamma globulins
B) An insect bite
C) Rheumatic heart disease and its sequelae
D) Sepsis and its sequelae

Answer 37

Ans: C
Feedback:
The most common cause of mitral valve regurgitation in developing countries is rheumatic heart disease and its sequelae.

Question 38

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.
A) Anxiety
B) Fatigue
C) Shoulder pain
D) Tachypnea
E) Palpitations

Answer 38

Ans: A, B, E
Feedback:
Most people who have mitral valve prolapse never have symptoms. A few have symptoms of fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, and anxiety. Hyperpnea and shoulder pain are not characteristic symptoms of mitral valve prolapse.

Question 39

A cardiac surgery patients new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurses most appropriate action?
A) Prepare to assist with pericardiocentesis.
B) Reposition the patient into a prone position.
C) Administer a dose of metoprolol.
D) Administer a bolus of normal saline.

Answer 39

Ans: A
Feedback:
Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.

Question 40

The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis?
A) Wheezes
B) Friction rub
C) Fine crackles
D) Coarse crackles

Answer 40

Ans: B
A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these occurs with pericarditis.