UNIT 4: Management of Patients with structural Infections and Inflammatory Cardiac Disorders

Question 1

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

Answer 1

ANS: C
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 disorde

Question 2

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

Answer 2

ANS: C
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

Question 3

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.

Answer 3

ANS: D
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.

Question 4

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

Answer 4

ANS: D
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.

Question 5

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

Answer 5

ANS: B
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.

Question 6

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

Answer 6

ANS: B
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.

Question 7

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.

Answer 7

ANS: B
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.

Question 8

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

Answer 8

ANS: B
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.

Question 9

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

Answer 9

ANS: B
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.

Question 10

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

Answer 10

ANS: A
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.

Question 11

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

Answer 11

ANS: A
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

Question 12

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

Answer 12

ANS: C
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

Question 13

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

Answer 13

ANS: A
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.

Question 14

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.”

Answer 14

ANS: C
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.

Question 15

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

Answer 15

ANS: B
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.

Question 16

The staff educator is presenting a workshop on valvular disorders. When discussing
the pathophysiology of aortic regurgitation, the educator describes what consequence of
this disorder?
A. Cardiac tamponade
B. Left ventricular hypertrophy
C. Right-sided heart failure
D. Ventricular insufficiency

Answer 16

ANS: B
Rationale: 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 17

The nurse is creating a plan of care for a client with cardiomyopathy. Which goal
would be a priority for the client?
A. Absence of complications
B. Adherence to the self-care program
C. Improved cardiac output
D. Increased activity tolerance

Answer 17

ANS: C
Rationale: The priority nursing diagnosis of a client 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 18

An older adult client has been diagnosed with aortic regurgitation. Which change in
blood flow should the nurse expect to see on this client’s 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 18

ANS: A
Rationale: 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 19

A client who has undergone valve replacement surgery is being prepared for
discharge home. Because the client will be discharged with a prescription for warfarin,
the nurse would educate the client about the need to take which action?
A. Undergo regular testing of the International Normalized Ratio (INR).
B. Sleep in a semi-Fowler position for the first 6 to 8 weeks to prevent emboli.
C. Avoid foods that contain vitamin K.
D. Take enteric-coated acetylsalicylic acid (ASA) on a daily basis.

Answer 19

ANS: A
Rationale: Clients who take warfarin 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 20

A nurse is planning discharge health education for a client who will soon undergo
placement of a mechanical valve prosthesis. Which topic would the nurse prioritize?
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 20

ANS: D
Rationale: Clients with a mechanical valve prosthesis (including annuloplasty rings and
other prosthetic materials used in valvuloplasty) require education to prevent infective
endocarditis. Despite these infection 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 21

A client with mitral valve stenosis is receiving health education at an outpatient clinic.
To minimize the client’s symptoms, the nurse would teach the client to take which action?
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 21

ANS: B
Rationale: Clients 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 22

A client is admitted to the critical care unit with a diagnosis of cardiomyopathy. When
reviewing the client’s most recent laboratory results, the nurse would prioritize
assessment of which value?
A. Sodium
B. Aspartate aminotransferase, alanine aminotransferase, and bilirubin
C. White blood cell differential
D. Blood urea nitrogen (BUN)

Answer 22

ANS: A
Rationale: 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 23

A client is a candidate for percutaneous balloon valvuloplasty, but is concerned about
how this procedure will affect the client’s busy work schedule. Which guidance would the
nurse provide to the client?
A. “Clients generally stay in the hospital for 6 to 8 days.”
B. “Clients are kept in the hospital until they are independent with all aspects of
their care.”
C. “Clients need to stay in the hospital until they regain normal heart function for
their age.”
D. “Clients usually remain at the hospital for 24 to 48 hours.”

Answer 23

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

Question 24

A client has been diagnosed with a valvular disorder. The client tells the nurse that
the client has read about numerous treatment options, including valvuloplasty. Which
statement would be most appropriate for the nurse to make regarding valvuloplasty?
A. “For some clients, 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. “It’s prudent to get a second opinion before deciding to have valvuloplasty.”

Answer 24

ANS: A
Rationale: 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 25

The client has just returned to the floor after balloon valvuloplasty of the aortic valve
and the nurse is planning appropriate assessments. The nurse would assess for
indications of which potential complications? Select all that apply.
A. Emboli
B. Mitral valve damage
C. Ventricular dysrhythmia
D. Atrial-septal defect
E. Plaque formation

Answer 25

ANS: A, B, C
Rationale: 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 26

The nurse is caring for a client with right ventricular hypertrophy and, consequently,
decreased right ventricular function. What valvular disorder may have contributed to this
client’s diagnosis?
A. Mitral valve regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral valve stenosis

Answer 26

ANS: D
Rationale: 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 27

The cardiac nurse is caring for a client 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 27

ANS: A
Rationale: 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 clients with DCM

Question 28

A 17-year-old client is being treated in the intensive care unit after going into cardiac
arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause
of the arrest. Which 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 28

ANS: C
Rationale: 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 29

A client has been living with dilated cardiomyopathy for several years but has
experienced worsening symptoms despite aggressive medical management. The nurse
would anticipate which potential treatment?
A. Heart transplantation
B. Balloon valvuloplasty
C. Cardiac catheterization
D. Stent placement

Answer 29

ANS: A
Rationale: 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 30

A client is being discharged home after a heart transplant. The nurse is preparing to
provide medication education on cyclosporine and tacrolimus. Which nursing diagnosis
would be prioritized for this client?
A. Risk for injury
B. Risk for infection
C. Risk for peripheral neurovascular dysfunction
D. Risk for unstable blood glucose

Answer 30

ANS: B
Rationale: Immunosuppressants decrease the body’s 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 31

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

Answer 31

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

Question 32

A client 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?
A. Sudden changes in level of consciousness (LOC)
B. Peripheral edema and pulmonary edema
C. Pleuritic chest pain
D. Flulike symptoms

Answer 32

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

Question 33

Which classification of clients would be at greatest risk for hospital-acquired
endocarditis?
A. Hemodialysis clients
B. Clients on immunoglobulins
C. Clients who undergo intermittent urinary catheterization
D. Children under the age of 12

Answer 33

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

Question 34

Which factor is the most common cause of mitral valve regurgitation in developing
countries?
A. A decrease in gamma globulins
B. An insect bite
C. Rheumatic heart disease and its sequelae
D. Sepsis and its sequelae

Answer 34

ANS: C
Rationale: The most common cause of mitral valve regurgitation in developing countries
is rheumatic heart disease and its sequelae, not a decrease in gamma globulins, an insect
bite, or sepsis and its sequelae.

Question 35

The nurse is caring for a client with mitral valve prolapse. Which symptoms would be
consistent with this diagnosis? Select all that apply.
A. Anxiety
B. Fatigue
C. Shoulder pain
D. Tachypnea
E. Palpitations

Answer 35

ANS: A, B, E
Rationale: 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 36

A postoperative cardiac client experiences signs and symptoms of cardiac
tamponade. Which action by the nurse would be most appropriate?
A. Prepare to assist with pericardiocentesis.
B. Reposition the client into a prone position.
C. Administer a dose of metoprolol as prescribed.
D. Administer a bolus of normal saline as prescribed.

Answer 36

ANS: A
Rationale: 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 37

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

Answer 37

ANS: B
Rationale: 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