Chapter 24 - Structural, Infectious, and Inflammatory Cardiac Disorders Flashcards
A client with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the client to exhibit which heart rhythm? A. Ventricular fibrillation (VF) B. Ventricular tachycardia (VT) C. Atrial fibrillation D. Sinus bradycardia
C. Atrial fibrillation
Rationale: In clients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation caused by strain on the atrium. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
A client who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse would discuss the importance of antibiotic prophylaxis prior to which event?
A. Exposure to immunocompromised individuals
B. Future hospital admissions
C. Dental procedures
D. Live vaccinations
C. Dental procedures
Rationale: 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.
The critical care nurse is caring for a client who is receiving cyclosporine postoperative heart transplant. What outcome represents a therapeutic outcome of this pharmacologic treatment?
A. The client remains free of thrombus formation.
B. The client maintains adequate cardiac output.
C. The client has an increase in white cell count.
D. The client does not experience organ rejection
D. The client does not experience organ rejection
Rationale: After heart transplant, clients are constantly balancing the risk of rejection with the risk of infection. Most commonly, clients receive medications such as cyclosporine to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.
A client with a history of rheumatic heart disease knows that the client is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the client knows the importance of taking which drug? A. Enoxaparin B. Metoprolol C. Azathioprine D. Amoxicillin
D. Amoxicillin
Rationale: Although rare, bacterial endocarditis may be life threatening. A key strategy is primary prevention in high-risk clients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic
A client with pericarditis has just been admitted to the critical care unit. The nurse planning the client’s care should prioritize which 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
B. Acute pain related to pericarditis
Rationale: 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.
A client 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. Which valvular disorder would the nurse anticipate being diagnosed in this client? A. Aortic regurgitation B. Mitral stenosis C. Mitral valve prolapse D. Aortic stenosis
B. Mitral stenosis
Rationale: 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. Clients 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. Clients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea, and repeated respiratory infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.
The nurse is caring for a client with mitral stenosis who is scheduled for a balloon valvuloplasty. The client reports being unsure of why the surgeon did not opt to replace the damaged valve rather than repair it. Which statement indicates an advantage of valvuloplasty that the nurse should cite?
A. The procedure can be performed on an outpatient basis in a health care provider’s office.
B. Repaired valves tend to function longer than replaced valves.
C. The procedure is not associated with a risk of infection.
D. Lower doses of antirejection drugs are required than with valve replacement
B. Repaired valves tend to function longer than replaced valves.
Rationale: In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and clients do not require continuous anticoagulation. Valvuloplasty carries a risk of infection, like all surgical procedures, and it is not performed in a health care provider’s office. Antirejection drugs are unnecessary because foreign tissue is not introduced.
The nurse is reviewing the echocardiography results of a client who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure is this client experiencing?
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
B. Dilated ventricles without hypertrophy of the ventricles
Rationale: DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in clients with DCM.
A client has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The health care provider's choice of antibiotics would be primarily based on what diagnostic test? A. Echocardiography B. Blood cultures C. Cardiac aspiration D. Full blood count
B. Blood cultures
Rationale: To help determine the causative organisms and the most effective antibiotic treatment for the client, 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.
Which intervention is 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. Promoting smoking cessation in all clients who smoke
A. Recognizing and promptly treating streptococcal infections
Rationale: 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.
The nurse is caring for a client with a history of endocarditis. Which topic would the nurse prioritize during health promotion education? A. Oral hygiene B. Physical activity C. Dietary guidelines D. Fluid intake
Rationale: For clients with endocarditis, regular professional oral care combined with personal oral care may reduce the risk of bacteremia. In most cases, diet and fluid intake do not need to be altered. Physical activity has broad benefits, but it does not directly prevent complications of endocarditis
The nurse is admitting a client with a diagnosis of left ventricular hypertrophy. The client reports dyspnea on exertion, as well as fatigue. Which diagnostic tool would be most helpful in diagnosing this type of myopathy? A. Cardiac catheterization B. Arterial blood gases C. Echocardiogram D. Exercise stress test
C. Echocardiogram
Rationale: The echocardiogram (ECG) 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 arrhythmias 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
The nurse is preparing a client for cardiac surgery. During the procedure, the client's heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this client undergo? A. Orthotopic transplant B. Xenograft C. Heterotopic transplant D. Homograft
A. Orthotopic transplant
Rationale: Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipient’s heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipient’s heart, leaving a portion of the recipient’s 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 heterotopic transplantation are not terms used to describe heart transplantation
A client is undergoing diagnostic testing for mitral stenosis. What statement by the client during the nurse’s 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 I’m 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.”
C. “Whenever I do any form of exercise I get terribly short of breath.”
Rationale: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Clients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some clients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.
The nurse is caring for a client who is scheduled to undergo mechanical valve replacement. Client education would include coverage of which intervention? A. Use of client-controlled analgesia B. Long-term anticoagulant therapy C. Steroid therapy D. Use of IV diuretics
B. Long-term anticoagulant therapy
Rationale: Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and client-controlled analgesia may or may be not be used in the immediate postoperative period
