Chapter 40: Myocarditis

Question 1

The nurse is educating a student about cytokine involvement in myocarditis. Which statement by the student indicates understanding?

A. “Cytokines repair damaged myocardial cells.”

B. “Cytokines contribute to the inflammatory and immune responses that damage the heart.”

C. “Cytokines are produced only during the late stages of myocarditis.”

D. “Cytokines prevent the progression of heart dysfunction in myocarditis.”

Answer 1

B. “Cytokines contribute to the inflammatory and immune responses that damage the heart.”

Rationale: Cytokines are released as part of the immune response during myocarditis, contributing to inflammation and further destruction of the myocardium.

Question 2

What complication is most likely to develop in a client with myocarditis?

A. Cardiomyopathy
B. Deep vein thrombosis
C. Pulmonary embolism
D. Chronic obstructive pulmonary disease

Answer 2

A. Cardiomyopathy

Rationale: Myocarditis can lead to cardiomyopathy due to the inflammatory process causing structural and functional abnormalities in the heart muscle.

Question 3

A client with myocarditis asks why they are experiencing heart dysfunction. The nurse explains that this is due to:

A. Fluid overload from heart failure

B. Direct cellular invasion and immune-mediated destruction

C. Decreased oxygen supply to the coronary arteries

D. Scarring and calcification of the myocardium

Answer 3

B. Direct cellular invasion and immune-mediated destruction

Rationale: Myocarditis involves cellular damage caused by infectious agents and the immune system, leading to myocardial dysfunction.

Question 4

Which intervention is most appropriate for managing a patient with myocarditis?

A. Administering antibiotics for bacterial causes

B. Encouraging high-intensity exercise to maintain cardiac output

C. Providing supportive care to reduce myocardial workload

D. Administering anticoagulants to prevent clot formation

Answer 4

C. Providing supportive care to reduce myocardial workload

Rationale: Treatment for myocarditis focuses on supportive care, such as reducing myocardial workload, improving cardiac function, and managing complications like heart failure.

Question 5

The nurse understands that which of the following patients is at highest risk for developing myocarditis?

A. A patient with a history of autoimmune disease

B. A patient with controlled hypertension

C. A patient recovering from a hip replacement

D. A patient with a history of peptic ulcer disease

Answer 5

A. A patient with a history of autoimmune disease

Rationale: Autoimmune disorders, such as polymyositis, have been linked with the development of myocarditis due to the autoimmune response targeting the myocardium.

Question 6

Which of the following findings should the nurse monitor to assess the progression of myocarditis?

A. Blood pressure changes
B. Liver enzyme levels
C. Hemoglobin and hematocrit levels
D. Ejection fraction on echocardiogram

Answer 6

D. Ejection fraction on echocardiogram

Rationale: Myocarditis can lead to myocardial dysfunction, which may manifest as a decreased ejection fraction. Monitoring cardiac function is essential for evaluating disease progression.

Question 7

What is the primary mechanism of cellular damage in myocarditis?

A. Hypoxia-induced cellular death

B. Invasion by causative agents and immune-mediated injury

C. Chronic hypertension leading to ischemia

D. Hypercoagulability leading to thrombosis

Answer 7

B. Invasion by causative agents and immune-mediated injury

Rationale: Myocarditis begins with direct invasion of myocytes by causative agents, followed by immune activation, release of cytokines, and an autoimmune response that further damages myocytes.

Question 8

A nurse is caring for a client diagnosed with viral myocarditis. Which causative agent is most commonly associated with this condition?

A. Streptococcus pneumonia

B. Candida albicans

C. Epstein-Barr virus

D. Coxsackie B virus

Answer 8

D. Coxsackie B virus

Rationale: Coxsackie A and B viruses are the most common causative agents of viral myocarditis. Bacteria, fungi, and other viruses may cause myocarditis but are less common.

Question 9

Which early manifestations should the nurse expect in a client with viral myocarditis?

A. Crackles and JVD
B. Fever, fatigue, and myalgias
C. Peripheral edema and syncope
D. Angina and pleuritic chest pain

Answer 9

B. Fever, fatigue, and myalgias

Rationale: Early symptoms of viral myocarditis often mimic those of a viral illness and include fever, fatigue, malaise, and myalgias.

Question 10

A client with myocarditis develops a pericardial friction rub. This finding is most indicative of:

A. Pericarditis
B. Heart failure
C. Cardiomyopathy
D. Myocardial infarction

Answer 10

A. Pericarditis

Rationale: Pericarditis often accompanies myocarditis, and a pericardial friction rub is a hallmark sign of inflammation of the pericardium.

Question 11

The nurse auscultates an S3 heart sound in a client with myocarditis. This finding indicates:

A. Progression to heart failure
B. Early infection
C. Resolution of myocarditis
D. Normal cardiac function

Answer 11

A. Progression to heart failure

Rationale: An S3 heart sound is a late sign of myocarditis and is associated with the development of heart failure due to impaired ventricular function.

Question 12

Which symptom reported by the client suggests a late-stage manifestation of myocarditis?

A. Nausea and vomiting
B. Pleuritic chest pain
C. Pharyngitis
D. Syncope

Answer 12

D. Syncope

Rationale: Syncope is a late manifestation of myocarditis, often related to the development of heart failure or arrhythmias.

Question 13

A nurse is assessing a client with myocarditis. Which finding is most concerning and requires immediate intervention?

A. Fatigue and dyspnea
B. Pleuritic chest pain
C. Peripheral edema and crackles
D. Lymphadenopathy

Answer 13

C. Peripheral edema and crackles

Rationale: These findings indicate fluid overload and heart failure, requiring prompt intervention to prevent further cardiac decompensation.

Question 14

The nurse understands that early cardiac signs of myocarditis typically appear:

A. 1 to 3 days after infection
B. 7 to 10 days after viral infection
C. 2 weeks after infection
D. At the time of heart failure development

Answer 14

B. 7 to 10 days after viral infection

Rationale: Early cardiac manifestations, such as chest pain or arrhythmias, usually develop 7 to 10 days after the onset of a viral infection.

Question 15

Which of the following findings is most consistent with pericardial effusion in a client with myocarditis?

A. Increased urine output
B. Bounding pulses
C. Muffled heart sounds
D. Narrow pulse pressure

Answer 15

C. Muffled heart sounds

Rationale: Muffled heart sounds are a common sign of pericardial effusion, which may occur with pericarditis in myocarditis.

Question 16

What is the primary reason antivirals are not always used in myocarditis treatment?

A. They exacerbate heart failure symptoms.
B. They are effective only during the acute phase of viral infection.
C. They interfere with anticoagulation therapy.
D. They reduce ESR and CRP levels.

Answer 16

B. They are effective only during the acute phase of viral infection.

Rationale: Antivirals are only effective during the acute phase when the virus is active, typically within the first 8 to 10 days of illness.

Question 17

The nurse is reviewing medications for a client with myocarditis. Which drug combination requires clarification with the provider?

A. Digoxin and diuretics
B. ACE inhibitors and β-blockers
C. Anticoagulants and immunosuppressive agents
D. Digoxin and nitroprusside

Answer 17

D. Digoxin and nitroprusside

Rationale: Caution is required with digoxin due to its potential toxicity. Using it alongside vasodilators like nitroprusside may complicate hemodynamic stability.

Question 18

A nurse is educating a client about restricted activity in myocarditis. The client asks why this is necessary. The nurse should respond:

A. “It prevents the spread of infection.”
B. “It reduces cardiac workload and allows recovery.”
C. “It eliminates the need for medication.”
D. “It prevents blood clot formation.”

Answer 18

B. “It reduces cardiac workload and allows recovery.”

Rationale: Rest and restricted activity are essential to decrease cardiac workload and promote myocardial recovery.

Question 19

What is the primary benefit of diuretics in the treatment of myocarditis?

A. Reduce fluid volume and preload
B. Increase afterload
C. Decrease myocardial inflammation
D. Lower heart rate

Answer 19

A. Reduce fluid volume and preload

Rationale: Diuretics help manage heart failure symptoms by reducing fluid volume and preload, alleviating stress on the heart.

Question 20

The nurse notes diffuse crackles in a client with myocarditis. This finding is most consistent with:

A. Pericardial effusion from heart failure
B. Viral infection from heart failure
C. Pulmonary congestion from heart failure
D. Cardiac tamponade from heart failure

Answer 20

C. Pulmonary congestion from heart failure

Rationale: Crackles are a sign of fluid buildup in the lungs, often caused by heart failure due to impaired myocardial function.

Question 21

Which client with myocarditis is most likely to benefit from immunosuppressive therapy?

A. A client with bacterial myocarditis
B. A client with mild viral myocarditis
C. A client with normal cardiac function
D. A client with autoimmune myocarditis

Answer 21

D. A client with autoimmune myocarditis

Rationale: Immunosuppressive agents are used to reduce heart inflammation and damage in cases of myocarditis with an autoimmune basis.

Question 22

What is the primary goal of using ACE inhibitors in myocarditis?

A. Increase heart rate
B. Reduce myocardial workload and treat heart failure
C. Increase sodium and fluid retention
D. Promote clot formation

Answer 22

B. Reduce myocardial workload and treat heart failure

Rationale: ACE inhibitors reduce myocardial workload and improve cardiac output by lowering blood pressure and decreasing afterload.

Question 23

Which supportive measure is most appropriate for a client with severe heart failure secondary to myocarditis?

A. Intraaortic balloon pump therapy
B. Long-term corticosteroid use
C. Encouraging moderate physical activity
D. Increasing sodium intake

Answer 23

A. Intraaortic balloon pump therapy

Rationale: Intraaortic balloon pump therapy may be required in severe heart failure to assist with cardiac output.

Question 24

A client with myocarditis is receiving milrinone. The nurse understands that this medication’s primary purpose is to:

A. Increase systemic vascular resistance.
B. Increase heart rate.
C. Decrease afterload and improve cardiac output.
D. Reduce inflammation.

Answer 24

C. Decrease afterload and improve cardiac output.

Rationale: Milrinone is used to reduce afterload by decreasing systemic vascular resistance, thereby improving cardiac output.

Question 25

Why must digoxin be used with caution in myocarditis? A. It causes significant hypotension. B. Patients are more sensitive to its adverse effects and potential toxicity. C. It increases the risk of leukocytosis. D. It reduces cardiac output in these patients.

Answer 25

B. Patients are more sensitive to its adverse effects and potential toxicity. Rationale: Myocarditis increases sensitivity to digoxin, heightening the risk of dysrhythmias and toxicity.

Question 26

A nurse caring for a client with myocarditis notes an EF of 30%. Which intervention is most appropriate? A. Administer anticoagulants B. Increase IV fluid rate C. Discontinue ACE inhibitors D. Promote early ambulation

Answer 26

A. Administer anticoagulants Rationale: A low ejection fraction increases the risk of clot formation from blood stasis, making anticoagulation necessary.

Question 27

When is the virus most likely to be detected in tissue and pericardial fluid samples in myocarditis? A. 1 to 3 days after symptoms begin B. During the first 8 to 10 days of illness C. After 2 weeks of illness D. Only in the chronic phase

Answer 27

B. During the first 8 to 10 days of illness Rationale: The virus is generally detectable in tissue and pericardial fluid samples only during the first 8 to 10 days of illness.

Question 28

What is the most definitive diagnostic test for myocarditis? A. Echocardiogram B. MRI C. ECG D. Endomyocardial biopsy

Answer 28

D. Endomyocardial biopsy Rationale: Endomyocardial biopsy provides histologic confirmation of myocarditis, particularly during the first 6 weeks of acute illness.

Question 29

Which laboratory finding is most indicative of inflammation in myocarditis? A. Increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels B. Elevated cardiac biomarkers C. Low white blood cell count D. Normal viral titers

Answer 29

A. Increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels Rationale: Elevated ESR and CRP indicate systemic inflammation, which is commonly seen in myocarditis.

Question 30

Which ECG finding is most commonly associated with myocarditis? A. ST-segment elevation in specific leads B. Prolonged QT interval C. Normal sinus rhythm D. Diffuse ST-segment changes

Answer 30

D. Diffuse ST-segment changes Rationale: Nonspecific ECG changes in myocarditis often reflect pericardial involvement, such as diffuse ST-segment changes.

Question 31

What is the primary goal of nursing interventions for a patient with myocarditis? A. Prevent infection and reduce fever B. Improve cardiac output and manage heart failure symptoms C. Enhance physical activity and endurance D. Promote weight gain and nutritional intake

Answer 31

B. Improve cardiac output and manage heart failure symptoms Rationale: Nursing interventions focus on improving cardiac output and addressing symptoms of heart failure to reduce cardiac workload.

Question 32

Which nursing action best helps to decrease the cardiac workload in a patient with myocarditis? A. Encouraging frequent ambulation B. Placing the patient in a semi-Fowler’s position C. Providing a high-sodium diet D. Increasing IV fluid intake

Answer 32

B. Placing the patient in a semi-Fowler’s position Rationale: The semi-Fowler’s position reduces venous return and pulmonary congestion, decreasing cardiac workload.

Question 33

Why is it important to space activity and rest periods for a patient with myocarditis? A. To prevent blood clots B. To promote muscle strength C. To avoid fatigue and reduce cardiac stress D. To encourage fluid balance

Answer 33

C. To avoid fatigue and reduce cardiac stress Rationale: Spacing activities and rest prevents overexertion and decreases the workload on the heart.

Question 34

Which nursing intervention is most appropriate to reduce anxiety in a patient with myocarditis? A. Administering sedatives routinely B. Restricting visitors to limit distractions C. Increasing monitoring frequency D. Keeping the patient informed about the therapeutic plan

Answer 34

D. Keeping the patient informed about the therapeutic plan Rationale: Educating the patient and caregiver reduces anxiety by fostering understanding and involvement in care.

Question 35

A patient with myocarditis is receiving immunosuppressive therapy. Which nursing intervention is the highest priority? A. Assessing for signs of infection B. Monitoring for cardiac dysrhythmias C. Evaluating therapeutic drug levels D. Encouraging ambulation to prevent DVT

Answer 35

A. Assessing for signs of infection Rationale: Immunosuppressive therapy increases infection risk, making infection prevention and monitoring a top priority.

Question 36

Which finding in a patient with myocarditis may indicate progression to dilated cardiomyopathy? A. Normal ejection fraction B. Decreased ESR and CRP levels C. Enlarged heart with impaired contractility D. Resolution of heart failure symptoms

Answer 36

C. Enlarged heart with impaired contractility Rationale: Dilated cardiomyopathy involves an enlarged, weakened heart that cannot pump blood effectively.

Question 37

What is the nurse’s priority assessment for a patient with severe heart failure secondary to myocarditis? A. Monitoring liver enzymes B. Assessing for JVD and crackles C. Checking for muscle strength D. Evaluating viral titers

Answer 37

B. Assessing for JVD and crackles Rationale: Signs such as JVD and crackles indicate worsening heart failure and require immediate intervention.

Question 38

What complication should the nurse monitor for in a patient with myocarditis who is being considered for a heart transplant? A. Persistent arrhythmias B. Decreased oxygen saturation C. Acute renal failure D. Dehydration

Answer 38

A. Persistent arrhythmias Rationale: Severe myocarditis can lead to life-threatening arrhythmias, often necessitating advanced interventions like a heart transplant.

Question 39

Why is a quiet environment essential for patients with myocarditis? A. To prevent sensory overload B. To decrease sympathetic nervous system activation C. To promote immune function D. To reduce the risk of infection

Answer 39

B. To decrease sympathetic nervous system activation Rationale: A quiet environment minimizes stress and helps reduce the cardiac workload.

Question 40

A patient with myocarditis is prescribed nitroprusside. What is the nurse's priority assessment? A. Monitoring potassium levels B. Checking for hypotension C. Assessing for muscle weakness D. Evaluating fluid intake and output

Answer 40

B. Checking for hypotension Rationale: Nitroprusside is a vasodilator that reduces afterload but may cause significant hypotension, requiring close monitoring.

Question 41

What should the nurse emphasize when teaching a patient with myocarditis about infection prevention? A. "Avoid all contact with pets and animals." B. "Wear a mask at all times while indoors." C. "Take antibiotics as prescribed to prevent illness." D. "Use proper hand hygiene and avoid large crowds."

Answer 41

D. "Use proper hand hygiene and avoid large crowds." Rationale: Hand hygiene and avoiding exposure to large groups reduce infection risk in immunocompromised patients.

Question 42

In monitoring the effectiveness of diuretics for a patient with myocarditis and heart failure, the nurse should prioritize: A. Daily weight measurement B. Monitoring viral titers C. Assessing for peripheral pulses D. Checking for hyperglycemia

Answer 42

A. Daily weight measurement Rationale: Weight changes indicate fluid retention or loss, helping assess the effectiveness of diuretic therapy.

Question 43

Which patient statement indicates a need for further education about myocarditis recovery? A. "I will get plenty of rest and avoid overexertion." B. "I need to stay on my medications to manage my symptoms." C. "Once I feel better, I can return to full activity immediately." D. "I will monitor for signs of infection and notify my provider."

Answer 43

C. "Once I feel better, I can return to full activity immediately." Rationale: Patients recovering from myocarditis should gradually resume activity and avoid sudden increases in exertion to prevent cardiac stress.

Question 44

Which intervention is a priority in nursing management of a patient with myocarditis? a. Providing meticulous skincare b. Assuring tight glycemic control c. Administering antibiotic prophylaxis d. Monitoring oxygenation and ventilation

Answer 44

d. Monitoring oxygenation and ventilation

Question 45

The nurse is assessing a patient with myocarditis before giving a scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider? a. Fatigue b. Leukocytosis c. Irregular pulse d. Generalized myalgia

Answer 45

c. Irregular pulse Rationale: Myocarditis predisposes the heart to digoxin-associated dysrhythmias and toxicity. The other findings are common symptoms of myocarditis and there is no urgent need to report these.