Orange
The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)?
a. Fever, chills, and diaphoresis.
b. Urine output less than 30 mL/hr.
c. Petechiae on the inside of the mouth and conjunctiva.
d. Increase in heart rate of 15 beats/minute with walking.
Urine output less than 30 mL/hr
Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output. Petechiae, fever, chills, and diaphoresis are symptoms of IE but are not caused by decreased cardiac output. An increase in pulse rate of 15 beats/min is normal with exercise.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. An appropriate intervention by the nurse for this problem is to
a. teach the patient to take deep, slow breaths to control the pain.
b. force fluids to 3000 mL/day to decrease fever and inflammation.
c. provide a fresh ice bag every hour for the patient to place on the chest.
d. place the patient in Fowler’s position, leaning forward on the overbed table.
place the patient in Fowler’s position, leaning forward on the overbed table.
Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend to increase pericardial pain. Ice does not decrease this type of inflammation and pain.
During discharge teaching with an older patient who had a mitral valve replacement with a mechanical valve, the nurse must instruct the patient on the
a. use of daily aspirin for anticoagulation.
b. correct method for taking the radial pulse.
c. need for frequent laboratory blood testing.
d. need to avoid any physical activity for 1 month.
need for frequent laboratory blood testing.
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.
The nurse obtains a health history from an older patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most focused on identifying a risk factor for IE?
A. “Do you have a history of a heart attack?”
b. “Is there a family history of endocarditis?”
c. “Have you had any recent immunizations?”
d. “Have you had dental work done recently?”
“Have you had dental work done recently?”
Dental procedures place the patient with a prosthetic mitral valve at risk for IE. Myocardial infarction, immunizations, and a family history of endocarditis are not risk factors for IE.
When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is most appropriate for the nurse to include?
a. Arrange for placement of a long-term IV catheter.
b. Monitor labs for levels of streptococcal antibodies.
c. Teach the importance of completing all oral antibiotics.
d. Encourage the patient to begin regular aerobic exercise.
Arrange for placement of a long-term IV catheter.
Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy to eradicate the bacteria, which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line. Rest periods and limiting physical activity to a moderate level are recommended during the treatment for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.
When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for
a. diastolic murmur. c. shortness of breath on exertion.
b. peripheral edema. d. right upper quadrant tenderness.
shortness of breath on exertion.
The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia, which is a priority.
A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which prescribed PRN medication will be the most appropriate for the nurse to give?
a. Fentanyl 1 mg IV c. Oral ibuprofen (Motrin) 600 mg
b. IV morphine sulfate 4 mg d. Oral acetaminophen (Tylenol) 650 mg
Oral ibuprofen (Motrin) 600 mg
The pain associated with pericarditis is caused by inflammation, so nonsteroidal antiinflammatory drugs (e.g., ibuprofen) are most effective. Opioid analgesics and acetaminophen are not very effective for the pain associated with pericarditis.
A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of
a. blood cultures. c. cardiac catheterization.
b. echocardiography. d. 24-hour Holter monitor.
echocardiography.
Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization and 24-hour Holter monitor are not diagnostic procedures for pericarditis.
A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of
a. blood cultures. c. cardiac catheterization.
b. echocardiography. d. 24-hour Holter monitor.
echocardiography.
Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization and 24-hour Holter monitor are not diagnostic procedures for pericarditis.
A 21-yr-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?
Biologic valves will require immunosuppressive drugs after surgery.
b. Mechanical mitral valves need to be replaced sooner than biologic valves.
c. Lifelong anticoagulant therapy is needed after mechanical valve replacement.
d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.
Lifelong anticoagulant therapy is needed after mechanical valve replacement.
Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biological valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system and immunosuppressive therapy is not needed.
When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for the development of
a. flank pain. c. shortness of breath.
b. splenomegaly. d. mental status changes.
shortness of breath.
Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain, changes in mental status, and splenomegaly would be associated with embolization from the left-sided valves.
When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for
a. diastolic murmur. c. shortness of breath on exertion.
b. peripheral edema. d. right upper quadrant tenderness.
shortness of breath on exertion.
The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia, which is a priority.
To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should
a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest.
b. auscultate with the diaphragm of the stethoscope on the lower left sternal border.
c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub.
d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.
auscultate with the diaphragm of the stethoscope on the lower left sternal border.
Pericardial friction rubs are best heard with the diaphragm at the lower left sternal border. The nurse should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.
While caring for a 23-yr-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. avoid over-the-counter (OTC) drugs that contain stimulants.
d. take an aspirin a day to prevent clots from forming on the valve.
avoid over-the-counter (OTC) drugs that contain stimulants.
The use of stimulant drugs should be avoided by patients with MVP because they may exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.
A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?
A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the health care provider about symptoms such as shortness of breath.
Notify the health care provider about symptoms such as shortness of breath.
The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.
A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?
a. A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the health care provider about symptoms such as shortness of breath.
Notify the health care provider about symptoms such as shortness of breath.
The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.