Chapter 28
Showing posts with label Chapter 28. Show all posts
Showing posts with label Chapter 28. Show all posts

The nurse obtains a health history from a patient with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?

The nurse obtains a health history from a patient with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?


a) Have you recently vacationed outside of the United States?

b) Do you live with any domesticated animals in your home?

c) Do you have a family history of endocarditis?

d) Have you been to the dentist recently?


Answer: Have you been to the dentist recently?

A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?

A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?


a) Exertional dyspnea, orthopnea, pulmonary edema

b) Nausea, vomiting, exertional fatigue

c) Syncope, fever, vomiting

d) Dizziness, nausea, diarrhea



Answer: Exertional dyspnea, orthopnea, pulmonary edema

A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur?

A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur?


a) Diastolic, rumbling, low-pitched

b) Systolic, harsh, crescendo-decrescendo

c) Diastolic, blowing, decrescendo

d) Pansystolic, blowing, high-pitched



Answer: Diastolic, rumbling, low-pitched

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following?

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following?


a) Open commissurotomy

b) Left ventricular assist device

c) Annuloplasty

d) Chordoplasty



Answer: Left ventricular assist device

The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a patient with a mechanical valve replacement. The patient's INR is 2.7. Which action should the nurse take?

The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a patient with a mechanical valve replacement. The patient's INR is 2.7. Which action should the nurse take?


a) Prepare to administer Vitamin K.

b) Asses the patient for abnormal bleeding.

c) Administer the medication as ordered.

d) Hold the medication and notify the HCP.



Answer: Administer the medication as ordered.


A patient with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. The nurse expects that collaborative management of the patient will include

A patient with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. The nurse expects that collaborative management of the patient will include


a) surgical valve replacement

b) embolectomy

c) administration of anticoagulants

d) higher than usual antibiotic dosages



Answer: surgical valve replacement

A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider.

A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider.


a) 3.0

b) 3.4

c) 3.8

d) 2.6



Answer: 3.8

A 45-year-old male client with a confirmed DVT is being discharged from the ED. Which of the following client statements indicates that the client has received proper nursing instruction and understands how to manage his condition?

A 45-year-old male client with a confirmed DVT is being discharged from the ED. Which of the following client statements indicates that the client has received proper nursing instruction and understands how to manage his condition?


a) "I need to do my leg exercises five times or more every hour."

b) "I should lie on my side with my knees bent when sleeping."

c) "I need to ice my leg every 2 hours for about 20 minutes."

d) "I should try not to drink too much during the daytime."


Answer: "I need to do my leg exercises five times or more every hour."

A nurse reviewing a patient's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and has an increase in overall size and mass, especially along the septum. The ventricular walls are thickened reducing the size of the ventricular cavities. Several areas of the myocardium have evidence of scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?

A nurse reviewing a patient's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and has an increase in overall size and mass, especially along the septum. The ventricular walls are thickened reducing the size of the ventricular cavities. Several areas of the myocardium have evidence of scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?


a) Restrictive

b) Arrhythmogenic right ventricular cardiomyopathy

c) Dilated

d) Hypertrophic



Answer: Hypertrophic

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis may be appropriate?

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis may be appropriate?


a) Decreased cardiac output

b) Risk for peripheral neurovascular dysfunction

c) Risk for deficient fluid volume

d) Ineffective thermoregulation



Answer: Decreased cardiac output

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:


a) notify the next shift to hold the daily 5 p.m. dose of warfarin.

b) assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin.

c) call the physician to request an increase in the warfarin dose.

d) give the client an I.M. vitamin K injection and notify the physician of the results.



Answer: assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin.

A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client?

A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client?


a) Foods to limit (green leafy vegetables) while taking warfarin

b) Symptoms to report of worsening tachycardia related to atrial fibrillation

c) The high risk for complications if she becomes pregnant while taking warfarin

d) Instructions for using the rhythm method



Answer: The high risk for complications if she becomes pregnant while taking warfarin

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume?

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume?


a) Supine

b) Semi-Fowler's

c) Leaning forward while sitting

d) Prone



Answer: Leaning forward while sitting

A patient with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which of the following manifestations that would indicate that the patient is developing pulmonary congestion?

A patient with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which of the following manifestations that would indicate that the patient is developing pulmonary congestion?


a) Tachycardia

b) A loud, blowing murmur

c) Hypertension

d) Shortness of breath



Answer: Shortness of breath

A nurse caring for a patient with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which of the following patient behaviors would indicate to the nurse that the patient's level of anxiety has decreased?

A nurse caring for a patient with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which of the following patient behaviors would indicate to the nurse that the patient's level of anxiety has decreased?


a) The patient eagerly awaits visits from family.

b) The patient answers questions about physical status with no problem.

c) The patient is resting in bed watching TV.

d) The patient is able to discuss the prognosis freely.



Answer: The patient is able to discuss the prognosis freely.

A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications?

A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications?


a) Thrombosis and infection

b) Evisceration

c) Bleeding and wound dehiscence

d) Bleeding and infection



Answer: Bleeding and infection

A patient comes to the clinic with complaints of fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which of the following preventable diseases?

A patient comes to the clinic with complaints of fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which of the following preventable diseases?


a) Pericarditis

b) Cardiomyopathy

c) Rheumatic fever

d) Mitral stenosis



Answer: Rheumatic fever

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