Chapter 29- Management of Patients With Structural, Infectious, and

1. A nurse is caring for a patient with mitral stenosis. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit which of the following heart rhythms? A) Normal sinus rhythm C) Atrial fibrillation B) Supraventricular tachycardia D) Electromechanical dissociation Ans: C Difficulty: Moderate 2. Patients with mitral stenosis may be placed on anticoagulant therapy. The nurse knows that this type of therapy may be instituted to decrease the risk of which of the following? A) Ventricular hypertrophy C) Deep vein thrombosis B) Pulmonary embolism D) Atrial thrombus Ans: D Difficulty: Moderate 3. When discussing the pathophysiology of aortic regurgitation with a patient, the nurse would emphasize that aortic regurgitation causes which of the following? A) Cardiac tamponade C) Right-sided heart failure B) Left ventricular hypertrophy D) Ventricular insufficiency Ans: B Difficulty: Moderate 4. When obtaining vital signs in a patient with aortic regurgitation, the nurse would expect which of the following? A) Widened pulse pressure B) Hypotension C) Tachycardia D) Bradypnea Ans: A Difficulty: Moderate 5. A nurse providing postoperative teaching to a patient who has received a valve replacement discusses the importance of antibiotic prophylaxis prior to any dental or surgical procedure. The nurse understands that antibiotic prophylaxis prevents which of the following in these patients? A) Otitis media B) Sepsis C) Bacterial endocarditis D) Deep vein thrombosis Ans: C Difficulty: Moderate 6. The nurse caring for a patient with hypertrophic cardiomyopathy knows that which of the following medication classifications should be avoided? A) Antihypertensives C) Diuretics B) Potassium supplements D) Antiarrhythmics Ans: C Difficulty: Moderate 7. A patient being admitted to the cardiac care unit complains of dyspnea on exertion and fatigue. His ECG demonstrates dysrhythmias associated with left ventricular
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A) B)

hypertrophy. Which of the following diagnostic tools would be the most helpful in diagnosing cardiomyopathy? Cardiac catheterization C) Echocardiogram Arterial blood gases D) Swan-Ganz analysis Ans: C Difficulty: Moderate

8. The nurse preparing a patient for cardiac surgery knows that which of the following procedures are completed when a recipient's heart is removed and the donor heart is implanted at the vena cava and pulmonary veins? A) Orthotropic transplant C) Heterotropic transplant B) Xenograft D) Homograft Ans: A Difficulty: Moderate 9. A postoperative heart transplant patient is receiving azathioprine (Imuran). The nurse understands that this medication is used for which of the following? A) Decreasing risk of thrombus C) Increasing number of white blood formation cells B) Ensuring adequate cardiac output D) Minimizing rejection Ans: D Difficulty: Moderate 10. When discussing the clinical manifestations of mitral stenosis with a patient on the cardiac unit, it would be important for the nurse to emphasize which of the following as the first symptom of mitral stenosis? A) Palpable arterial pulsations C) Difficulty breathing B) New murmur D) Mitral click Ans: C Difficulty: Moderate 11. When assessing a patient with mitral regurgitation, the nurse would expect which of the following heart sounds to occur? A) Diastolic murmur C) Systolic click B) Systolic murmur D) Ventricular dysrhythmias Ans: B Difficulty: Moderate 12. A patient is undergoing a valvuloplasty to repair a defective heart valve. Patient education is aimed at which of the following priority areas of teaching? A) Patient-controlled analgesia C) Long-term steroid therapy B) Long-term anticoagulant therapy D) Exercise program Ans: B Difficulty: Moderate 13. When discussing the pathophysiology of cardiomyopathy to a newly diagnosed patient,

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it would be important to stress that this disease process can lead to alterations in which of the following electrolytes? A) Sodium B) Potassium C) Chloride D) Magnesium Ans: A Difficulty: Moderate 14. The nurse developing a plan of care for a patient with cardiomyopathy should include which of the following priority outcomes? A) Absence of complications C) Improved cardiac output B) Adherence to the self-care program D) Increased activity tolerance Ans: C Difficulty: Moderate 15. The nurse discussing potential risk factors of infective endocarditis with a hospitalized patient would include which of the following as a potential risk factor of this disease process? A) Radiation exposure C) Sedentary lifestyle B) Prosthetic cardiac valves D) Cardiac catheterization Ans: B Difficulty: Moderate 16. The nurse is caring for a patient with rheumatic heart disease. To prevent bacterial endocarditis, the nurse would expect which of the following medications to be prescribed prior to any type of dental work. A) Enoxaparin (Lovenox) C) Azathioprine (Imuran) B) Metoprolol (Lopressor) D) Amoxicillin (Amoxil) Ans: D Difficulty: Moderate 17. When auscultating the breath sounds of a patient with pericarditis, the nurse would expect to find which of the following? A) Rales B) Wheezes C) Friction rub D) Rhonchi Ans: C Difficulty: Moderate 18. When assessing a patient with pericarditis, the nurse should be alerted to which of the following symptoms of the triad of cardiac tamponade? A) Absence of pain C) Rising arterial pressure B) Decreasing venous pressure D) Distant heart sounds Ans: D Difficulty: Moderate 19. When assessing a pericardial friction rub, the nurse knows that this type of sound has which of the following characteristics? A) Gallop C) Whistling sound B) Scratching or leathery sound D) Systolic click

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Ans: B Difficulty: Moderate 20. The nurse is caring for a newly admitted patient on the telemetry unit. The patient is experiencing progressive fatigue, hemoptysis, and dyspnea as a result of pulmonary venous hypertension due to which of the following valvular disorders? A) Aortic regurgitation C) Mitral valve prolapse B) Mitral stenosis D) Aortic stenosis Ans: B Difficulty: Difficult 21. A patient with aortic regurgitation is being transferred from the critical care unit to the step-down unit. The nurse receiving the patient in the step-down unit is aware that aortic regurgitation causes: 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 the left ventricle Ans: A Difficulty: Moderate 22. The nurse caring for a patient with aortic stenosis assesses for which common symptom? A) Angina pectoris B) Palpable arterial pulsations in the temporal arteries C) Repeated respiratory infections D) Orthopnea Ans: A Difficulty: Moderate 23. When teaching a patient about his or her valvular heart disease, the nurse instructs the patient to: A) Use prophylactic antibiotic treatment before dental work. B) Avoid any activity. C) Monitor weight biweekly. D) Ignore advancing signs of weakness because the disease process is progressive. Ans: A Difficulty: Moderate 24. The nurse caring for a patient who is scheduled for a balloon valvuloplasty recalls that balloon valvuloplasty is most commonly used for which valvular heart disease? A) Aortic regurgitation C) Mitral stenosis B) Mitral valve prolapse D) Mitral regurgitation Ans: C Difficulty: Moderate

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25. Upon receiving report of his assigned patients, the nurse learns he is assigned to care for a patient scheduled for a chordoplasty procedure. This procedure is used to: A) Repair valve annulus C) Repair chordae tendineae B) Repair leaflets D) Repair the commissure Ans: C Difficulty: Moderate 26. Following an implantation of a valve prosthesis, the nurse assesses the patient for the possible complication of: A) Heart failure C) Renal failure B) Hypothermia D) Vasospasm of the coronary arteries Ans: A Difficulty: Moderate 27. The nurse is performing an assessment on a patient who has presented to the emergency room with dilated cardiomyopathy (DCM). Which of the following changes in the heart characterizes DCM? A) Dilated ventricles with hypertrophy of the ventricles B) Dilated ventricles without hypertrophy of the ventricles C) Hypertrophy of the ventricles with no dilation of the ventricles D) Dilation of the atria and hypertrophy of the ventricles Ans: B Difficulty: Difficult 28. Restrictive cardiomyopathy is frequently first diagnosed when the patient experiences: A) Exertional dyspnea B) Cardiac arrest C) Extreme hunger D) Dehydration Ans: A Difficulty: Moderate 29. The nurse is reviewing diagnosis studies for a patient admitted with cardiomyopathy. What diagnostic finding is consistent with cardiomyopathy? A) Hypotrophy of the heart on chest radiograph B) Normal endomyocardial biopsy C) Minimal pulmonary blood flow D) ECG changes showing left ventricle hypertrophy Ans: D Difficulty: Moderate 30. A patient demonstrates an adequate understanding of fluid management associated with congestion secondary to her cardiomyopathy when she states: A) I will need to increase my fluids to 3 L/d to flush the fluids out of my system. B) I will need to restrict my fluids to 2 L/d to decrease congestion. C) I will need to restrict my fluids to 2 L/d to decrease the chances of developing a dysrhythmia. D) I will need to restrict my fluids to 2 L/d and increase my salt intake. Ans: B

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Difficulty: Moderate 31. A treatment regimen is being established for a patient with endocarditis. To find the most appropriate antibiotic treatment, which of the following tests would be the most helpful? A) Ultrasound of the heart B) Blood cultures C) ABG D) CBC Ans: B Difficulty: Moderate 32. A community health nurse is providing information to a group of parents on rheumatic heart disease. Which of the following is the most effective prevention of rheumatic heart disease? A) Recognizing and prompting treatment of streptococcal infections B) Adhering to antihypertensive medication treatment C) Lowering blood cholesterol D) Smoking cessation Ans: A Difficulty: Moderate 33. The nurse providing discharge teaching to a patient admitted with pericarditis informs him that pericarditis can lead to: A) Scarring of the mitral valve C) Inflammation of the endocardium B) Deformity of the valve leaflets D) Pericardial effusion Ans: D Difficulty: Moderate 34. A patient with mitral valve prolapse is scheduled to undergo a cystoscopy. Gentamicin is prescribed to be taken before the procedure to: A) Prevent bacterial endocarditis B) Prevent inflammation of the urethra C) Avoid antibiotic use during the procedure D) Decrease the need for surgical asepsis Ans: A Difficulty: Moderate

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