Chapter 40: Acute Pericarditis Flashcards
A nurse is assessing a patient with suspected acute pericarditis. Which clinical manifestation should the nurse expect to find?
A. Pericardial friction rub
B. Crackles in the lungs
C. Pulsus paradoxus
D. Systolic murmur
A. Pericardial friction rub
Rationale: A pericardial friction rub is a hallmark sign of pericarditis, caused by the inflamed pericardial layers rubbing against each other. Crackles in the lungs are associated with pulmonary conditions, pulsus paradoxus is more common in cardiac tamponade, and a systolic murmur is associated with valve disorders.
A patient with acute pericarditis reports sharp chest pain that worsens when lying flat. What intervention should the nurse recommend to alleviate this symptom?
A. Administer a beta-blocker
B. Encourage the patient to sit upright and lean forward
C. Provide a warm compress to the chest
D. Restrict oral fluid intake
B. Encourage the patient to sit upright and lean forward
Rationale: Sitting upright and leaning forward reduces pressure on the pericardium, decreasing pain. Beta-blockers are not indicated for symptom relief in pericarditis. Warm compresses and fluid restrictions are unrelated to managing the pain associated with pericarditis.
The nurse is educating a patient about the complications of acute pericarditis. Which complication should the nurse emphasize as requiring immediate medical attention?
A. Heart failure leading to cardiac tamponade
B. Atrial fibrillation leading to cardiac tamponade
C. Myocardial infarction leading to cardiac tamponade
D. Pericardial effusion leading to cardiac tamponade
D. Pericardial effusion leading to cardiac tamponade
Rationale: Cardiac tamponade, caused by rapid fluid accumulation in the pericardial sac, is a life-threatening complication of pericarditis requiring immediate intervention. Heart failure may occur but develops over time. Atrial fibrillation and myocardial infarction are not direct complications of pericarditis.
Which diagnostic test result is most indicative of acute pericarditis?
A. ST-segment elevation in all ECG leads
B. Low ejection fraction on echocardiogram
C. Elevated troponin levels
D. Decreased white blood cell count
A. ST-segment elevation in all ECG leads
Rationale: Diffuse ST-segment elevation is a characteristic finding in acute pericarditis. Low ejection fraction is not typically associated with pericarditis. Elevated troponin levels suggest myocardial injury, and a decreased WBC count is not associated with inflammation.
A nurse is preparing to discharge a patient diagnosed with acute pericarditis. Which statement by the patient indicates a need for further teaching?
A. “I should avoid strenuous activity until cleared by my doctor.”
B. “I will take my NSAIDs as prescribed to reduce inflammation.”
C. “If I have trouble breathing or feel faint, I should rest and wait for the symptoms to resolve.”
D. “I need to follow up with my healthcare provider regularly.”
C. “If I have trouble breathing or feel faint, I should rest and wait for the symptoms to resolve.”
Rationale: Trouble breathing or feeling faint may indicate complications such as cardiac tamponade, which requires immediate medical attention. This statement reflects a misunderstanding of the seriousness of these symptoms. The other statements demonstrate accurate understanding.
Which statement best describes the pathophysiology of acute pericarditis?
A. Rapid bacterial invasion leads to sepsis and necrosis of pericardial tissue.
B. Chronic immune activation causes myocardial fibrosis.
C. Inflammation of the pericardial sac results in neutrophil influx and fibrin deposition.
D. Coronary artery occlusion leads to ischemic pericardial damage.
C. Inflammation of the pericardial sac results in neutrophil influx and fibrin deposition.
Rationale: Acute pericarditis is characterized by an inflammatory process in the pericardial sac, resulting in neutrophil infiltration, increased vascularity, and fibrin deposition. This response may lead to pericardial effusion.
A patient diagnosed with viral pericarditis is asking how they may have developed the condition. Which response by the nurse is most appropriate?
A. “It is likely related to a recent respiratory or gastrointestinal illness.”
B. “This condition occurs only after surgery or trauma to the chest.”
C. “Pericarditis is always caused by bacterial infections.”
D. “This condition is usually caused by a genetic predisposition.”
A. “It is likely related to a recent respiratory or gastrointestinal illness.”
Rationale: Viral pericarditis commonly follows viral illnesses such as respiratory or gastrointestinal infections. It is not exclusive to surgery or trauma, and bacterial infections are less common causes.
A patient with suspected acute pericarditis reports severe chest pain. Which position would most likely alleviate the patient’s discomfort?
A. Lying flat on their back
B. Sitting up and leaning forward
C. Lying in a left lateral decubitus position
D. Sitting upright with legs elevated
B. Sitting up and leaning forward
Rationale: Chest pain from acute pericarditis is typically pleuritic and worsens when lying flat. Sitting up and leaning forward relieves pressure on the pericardial sac, reducing discomfort.
A nurse is reviewing a patient’s chart with chronic pericarditis. Which duration of symptoms would support this diagnosis?
A. 2-4 weeks
B. 6 weeks
C. 3-5 months
D. Over 6 months
D. Over 6 months
Rationale: Chronic pericarditis is defined as inflammation of the pericardium that persists for more than 6 months. Acute and subacute pericarditis occur over shorter durations.
A patient presents with a diagnosis of Dressler syndrome. The nurse knows this condition is most likely related to which of the following?
A. Viral infection following the flu
B. Autoimmune response after a large anterior myocardial infarction
C. Bacterial infection following cardiac surgery
D. Chronic heart failure with fluid overload
B. Autoimmune response after a large anterior myocardial infarction
Rationale: Dressler syndrome occurs 4-6 weeks post-myocardial infarction, particularly after a large anterior infarct, and is thought to be an autoimmune inflammatory reaction involving the pericardium.
Which laboratory finding is most consistent with the inflammatory process in acute pericarditis?
A. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
B. Decreased white blood cell count
C. Elevated creatine kinase-MB (CK-MB)
D. Decreased serum albumin
A. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
Rationale: Inflammatory markers such as CRP and ESR are typically elevated in acute pericarditis due to systemic inflammation. These markers are nonspecific but help support the diagnosis
A nurse is monitoring a patient for pericardial effusion. Which assessment finding should prompt immediate intervention?
A. Jugular vein distension (JVD) with muffled heart sounds
B. Bilateral pedal edema and ascites
C. Increased chest pain with deep inspiration
D. Pericardial friction rub heard on auscultation
A. Jugular vein distension (JVD) with muffled heart sounds
Rationale: JVD and muffled heart sounds, along with hypotension (Beck’s triad), are classic signs of cardiac tamponade, a life-threatening complication of pericardial effusion.
A patient with subacute pericarditis asks how this condition differs from acute pericarditis. What is the best response?
A. “Subacute pericarditis involves a bacterial infection, while acute pericarditis is viral.”
B. “Subacute pericarditis is less serious than acute pericarditis.”
C. “Subacute pericarditis is caused by heart failure, unlike acute pericarditis.”
D. “Subacute pericarditis develops weeks to months after an event, while acute pericarditis occurs rapidly.”
D. “Subacute pericarditis develops weeks to months after an event, while acute pericarditis occurs rapidly.”
Rationale: Subacute pericarditis is defined by a delayed onset, developing over weeks to months after a precipitating event, unlike acute pericarditis, which presents rapidly.
A patient with suspected acute pericarditis has a pericardial friction rub on auscultation. Where is the best location to hear this sound?
A. Over the left lower sternal border with the patient sitting upright
B. Over the apex of the heart in a left lateral decubitus position
C. At the base of the heart while the patient is supine
D. At the second intercostal space along the right sternal border
A. Over the left lower sternal border with the patient sitting upright
Rationale: A pericardial friction rub is best heard over the left lower sternal border when the patient is sitting upright and leaning forward. This position reduces the interference of lung sounds.
A nurse is assessing a patient with suspected acute pericarditis. Which of the following symptoms would most likely confirm the diagnosis?
A. Progressive, sharp chest pain that worsens with lying flat
B. Dull chest pain radiating to the jaw and associated with exertion
C. Chest pain that improves with nitroglycerin administration
D. Sudden, crushing chest pain that resolves with rest
A. Progressive, sharp chest pain that worsens with lying flat
Rationale: Acute pericarditis typically presents with sharp, pleuritic chest pain that worsens with lying flat and improves when sitting up and leaning forward. This pain may radiate to the neck, arms, or shoulder but is distinct from angina or myocardial infarction.
The nurse auscultates a high-pitched, scratching sound at the lower left sternal border of a patient suspected of having acute pericarditis. Which action should the nurse take to confirm that this is a pericardial friction rub?
A. Ask the patient to hold their breath and listen for the sound.
B. Reassess the sound while the patient is lying flat.
C. Have the patient cough to see if the sound resolves.
D. Observe for changes in the sound during inspiration and expiration.
A. Ask the patient to hold their breath and listen for the sound.
Rationale: A pericardial friction rub persists when the patient holds their breath, distinguishing it from a pleural friction rub, which disappears when the patient stops breathing.
A patient reports chest pain that radiates to the trapezius muscle and worsens with deep breathing. Which condition does the nurse suspect?
A. Stable angina
B. Acute pericarditis
C. Pulmonary embolism
D. Gastroesophageal reflux disease (GERD)
B. Acute pericarditis
Rationale: Chest pain radiating to the trapezius muscle (shoulder and upper back) is a distinguishing feature of acute pericarditis. This pain is often worsened by deep inspiration and lying flat
A patient with acute pericarditis is experiencing dyspnea. What is the most likely cause of this symptom?
A. Decreased cardiac output from pericardial effusion
B. Compression of the airway by the inflamed pericardium
C. Pulmonary congestion due to left-sided heart failure
D. Rapid, shallow breathing to avoid chest pain
D. Rapid, shallow breathing to avoid chest pain
Rationale: Patients with acute pericarditis often breathe in rapid, shallow breaths to minimize movement of the chest wall and reduce pain caused by pericardial inflammation.
The nurse is assessing a patient with chest pain caused by acute pericarditis. Which patient position will most likely relieve the pain?
A. Lying on the left side
B. Supine with knees elevated
C. Sitting up and leaning forward
D. Standing with arms crossed
C. Sitting up and leaning forward
Rationale: Sitting up and leaning forward reduces pressure on the pericardium and alleviates chest pain caused by acute pericarditis. Pain typically worsens when lying flat.
A patient presents with fever, sharp chest pain, and anxiety. What intervention should the nurse prioritize for this patient?
A. Administer antipyretics and benzodiazepines as prescribed
B. Encourage slow, deep breathing to reduce anxiety and dyspnea
C. Prepare for emergency pericardiocentesis
D. Administer oxygen at 4 L/min via nasal cannula
B. Encourage slow, deep breathing to reduce anxiety and dyspnea
Rationale: Fever and anxiety can exacerbate dyspnea in acute pericarditis. Encouraging slow, deep breathing helps to reduce anxiety and improve oxygenation. While other interventions may be appropriate, managing dyspnea and pain is the initial priority.
A patient with acute pericarditis reports progressive, severe chest pain. Which characteristic best differentiates this pain from angina?
A. Pain radiating to the trapezius muscle
B. Pain that improves with rest
C. Pain described as dull and aching
D. Pain that worsens with physical exertion
A. Pain radiating to the trapezius muscle
Rationale: Pain radiating to the trapezius muscle (shoulder or upper back) is specific to pericarditis and helps differentiate it from angina. Angina typically presents with dull, aching pain that resolves with rest.
The nurse is auscultating a patient with acute pericarditis. The pericardial friction rub is most likely to be heard during which phase of the cardiac cycle?
A. Systole only
B. Diastole only
C. Early systole
D. Both systole and diastole
D. Both systole and diastole
Rationale: A pericardial friction rub is typically heard during both systole and diastole due to friction between the inflamed pericardial layers. It has a characteristic scratching, grating quality.
A patient with pericarditis is being monitored for pericardial effusion. Which clinical manifestation would indicate compression of the phrenic nerve due to a large effusion?
A. Hoarseness
B. Hiccups
C. Cough
D. Dyspnea
B. Hiccups
Rationale: Phrenic nerve compression caused by a large pericardial effusion may lead to hiccups. Compression of other nearby structures, such as the laryngeal nerve or pulmonary tissue, can cause hoarseness, cough, or dyspnea.
The nurse is caring for a patient with suspected cardiac tamponade. Which of the following findings is most indicative of this condition?
A. Distant, muffled heart sounds and neck vein distention
B. Increased heart rate and widened pulse pressure
C. Pericardial friction rub and hypertension
D. Peripheral edema and bradycardia
A. Distant, muffled heart sounds and neck vein distention
Rationale: Cardiac tamponade is characterized by distant, muffled heart sounds, jugular vein distention, and decreased cardiac output. Narrowed pulse pressure is also commonly seen due to reduced stroke volume.
The nurse observes pulsus paradoxus in a patient with cardiac tamponade. How is pulsus paradoxus best described?
A. A bounding pulse alternating with a weak pulse
B. A pulse that disappears during deep inspiration
C. A decrease in systolic BP by more than 10 mmHg during inspiration
D. A difference in systolic BP greater than 20 mmHg between arms
C. A decrease in systolic BP by more than 10 mmHg during inspiration
Rationale: Pulsus paradoxus is a hallmark sign of cardiac tamponade and is defined as a decrease in systolic blood pressure by more than 10 mmHg during inspiration due to impaired ventricular filling.
A nurse is assessing a patient with pericardial effusion. Which symptom would most likely be present?
A. Muffled heart sounds and dyspnea
B. Loud heart sounds and hypertension
C. Pericardial friction rub and tachycardia
D. Sharp chest pain that radiates to the trapezius muscle
A. Muffled heart sounds and dyspnea
Rationale: Pericardial effusion often results in muffled heart sounds due to the fluid’s insulating effect and dyspnea caused by compression of pulmonary tissue.
A patient with cardiac tamponade is becoming increasingly restless and confused. What is the nurse’s priority action?
A. Administer oxygen via nasal cannula
B. Notify the healthcare provider immediately
C. Prepare the patient for pericardiocentesis
D. Monitor blood pressure every 15 minutes
B. Notify the healthcare provider immediately
Rationale: Restlessness and confusion in a patient with cardiac tamponade indicate decreased cardiac output and impaired perfusion, requiring immediate intervention. Preparing for pericardiocentesis and other supportive measures will follow provider notification.
The nurse is monitoring a patient with suspected cardiac tamponade. Which hemodynamic change would the nurse expect?
A. Increased cardiac output and widened pulse pressure
B. Increased blood pressure and bradycardia
C. Decreased blood pressure and widened pulse pressure
D. Decreased cardiac output and narrowed pulse pressure
D. Decreased cardiac output and narrowed pulse pressure
Rationale: Cardiac tamponade reduces cardiac output due to impaired ventricular filling, leading to hypotension and a narrowed pulse pressure.
A patient with pericarditis develops sudden tachypnea, tachycardia, and jugular vein distention. Which complication should the nurse suspect?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Cardiac tamponade
D. Pericardial effusion
C. Cardiac tamponade
Rationale: Tachypnea, tachycardia, jugular vein distention, and other signs such as muffled heart sounds and pulsus paradoxus suggest cardiac tamponade, a life-threatening complication requiring immediate intervention.
A patient presents with pericarditis caused by Dressler syndrome. What is the underlying mechanism?
A. Direct infection of the pericardium
B. Trauma to the chest wall
C. Fluid overload due to renal failure
D. Autoimmune reaction following myocardial infarction
D. Autoimmune reaction following myocardial infarction
Rational: Dressler syndrome is an autoimmune reaction that occurs weeks after a myocardial infarction, leading to pericarditis.
Which of the following is a common viral cause of acute pericarditis?
A. Hepatitis virus
B. Varicella-zoster virus
C. Neisseria gonorrhea
D. Coxsackie A and B viruses
C. Neisseria gonorrhea
Rationale: Neisseria gonorrhoeae is a bacterial pathogen, not a viral one. Hepatitis viruses, Coxsackie A and B, and varicella-zoster are common viral causes.
A nurse is caring for a patient with pericarditis caused by systemic sclerosis (scleroderma). Which classification best describes the etiology?
A. Infectious or autoimmune
B. Noninfectious or autoimmune
C. Hypersensitive or autoimmune
D. Idiopathic or autoimmune
C. Hypersensitive or autoimmune
Rationale: Systemic sclerosis (scleroderma) is a rheumatologic autoimmune condition that can lead to hypersensitive pericarditis.
