Professional Documents
Culture Documents
A)
B)
1.A patient with mitral stenosis exhibits symptoms of a dysrhythmia. Based on the
pathophysiology of this disease process, the nurse would expect the patient to exhibit
what heart rhythm?
Normal sinus rhythm
C) Atrial fibrillation
Supraventricular tachycardia
D) Electromechanical dissociation
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
The pulse is weak and often irregular because of atrial fibrillation (caused by the strain
on the atrium). A low-pitched, rumbling, diastolic murmur is heard at the apex. The
patient experiences atrial dysrthymias. An echocardiogram is used to diagnose mitral
stenosis.
2.A patient who has undergone a valve replacement with a mechanical valve prosthesis is
due to be discharged home. The nurse is giving discharge teaching and reinforcing
postoperative teaching to this patient. The nurse discusses the importance of antibiotic
prophylaxis prior to any dental or surgical procedure because the nurse understands that
antibiotic prophylaxis prevents what in these patients?
A) Otitis media B) Sepsis C) Bacterial endocarditis D) Deep vein thrombosis
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Patients with mechanical valve prosthesis require education to prevent bacterial
endocarditis with antibiotic prophylaxis, which is prescribed before all dental and
surgical interventions. Antibiotics may be ordered for sepsis and otitis media. The
question is asking how antibiotic prophylaxis is used in postoperative valve replacement
patients. Antibiotics are not generally ordered for patients with deep vein thrombosis.
A)
B)
3.A patient with hypertrophic cardiomyopathy has been admitted to your unit. What
classification of medication do you know should be avoided in these patients?
Antihypertensives
C) Diuretics
Potassium supplements
D) Antiarrythmics
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Ensuring that medications are taken as prescribed is important to preserving adequate
cardiac output. It is important to ensure that patients with hypertrophic cardiomyopathy
avoid diuretics. Patients with hypertrophic cardiomyopathy do not need to avoid
antihypertensives,
potassium supplements, or antiarrythmics.
4.You are caring for a postoperative heart transplant patient who is receiving azathioprine
Page 1
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
A)
B)
C)
D)
A)
B)
A)
B)
(Imuran). The patient asks you what this medication is for. What would your answer to
this patient be?
Azathioprine decreases the risk of thrombus formation.
Azathioprine ensures adequate cardiac output.
Azathioprine increases the number of white blood cells.
Azathioprine minimizes rejection.
Ans: D
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Heart transplant patients are constantly balancing the risk of rejection with the risk of
infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506,
Prograf), azathioprine (Imuran), or mycophenolate mofetil (CellCept), and
corticosteroids (prednisone) to minimize rejection. Therefore options A, B, and C are
incorrect.
5.A patient with rheumatic heart disease is at risk for bacterial endocartidis and has been
instructed to take what medication prior to any type of dental work.
Enoxaparin (Lovenox)
C) Azathioprine (Imuran)
Metoprolol (Lopressor)
D) Amoxicillin (Amoxil)
Ans: D
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary
prevention in high-risk patients (ie, those with rheumatic heart disease, mitral valve
prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for highrisk patients immediately before and sometimes after certain procedures.
6.A patient with pericarditis has been admitted to the CCU. The nurse caring for the patient
knows that the most common clinical manifestation of pericarditis is what?
Palpitations
C) Burning sensation in chest
Chest pain
D) Pounding heart rate
Ans: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
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. Options A, C, and D are incorrect.
7.A patient newly admitted to the telemetry unit is experiencing progressive fatigue,
Page 2
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
A)
B)
A)
B)
A)
B)
C)
D)
Page 3
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
10.A patient has been admitted with endocarditis. The patient asks the nurse how the
physician knows what medicines to order to kill the bacteria. The nurse knows that to
find the most appropriate antibiotic treatment what test would be the most helpful?
A) Ultrasound of the heart B) Blood cultures C) ABG D) CBC
Ans: B
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
To help determine the causative organisms and the most effective antibiotic treatment for
the patient, blood cultures are taken. CBC can help establish the degree and stage of
infection. An ultrasound of the heart and an ABG will not tell what the causative
organism of the endocarditis is.
11.A community health nurse is presenting an educational event at the local PTO. The nurse
is providing information on rheumatic heart disease. What would the nurse tell the PTO
is the most effective prevention of rheumatic heart disease?
A)
Recognizing and promptly treating streptococcal infections
B)
Adhering to antihypertenisve medication treatment
C)
Lowering blood cholesterol
D)
Smoking cessation
Ans: A
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Feedback:
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, lowering cholesterol and taking
antihypertensive medication will not prevent rheumatic heart disease.
12.A patient with mitral valve prolapse is admitted for a scheduled cystoscopy. The
physician has ordered gentamicin to be taken before the procedure. What is the rationale
for this?
A)
Prevent bacterial endocarditis
B)
Prevent inflammation of the urethra
C)
Avoid antibiotic use during the procedure
D)
Decrease need for surgical asepsis
Ans: A
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Patients with mitral valve prolapse may be at risk for infectious endocarditis resulting
Page 4
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
from bacteria entering the bloodstream and adhering to the abnormal valve structures.
The nurse teaches the patient how to minimize this risk: practicing good oral hygiene,
obtaining routine dental care, avoiding body piercing and body branding, and not using
toothpicks or other sharp objects in the oral cavity. Patients with mitral valve prolapse
are considered high risk for developing bacterial endocarditis during certain procedures
such as cystoscopy. Prophylactic antibiotic treatment is initiated to prevent
complications. Gentamicin would not be given to prevent inflammation of the urethra, to
avoid antibiotic use during the procedure, or to decrease the need for surgical aesepsis.
13.You are admitting a patient to the cardiac care unit with complaints of dyspnea on
exertion and fatigue. The patient's ECG shows dysrythmias associated with left
ventricular hypertrophy. What diagnostic tool would be the most helpful in diagnosing
cardiomyopathy?
A)
Cardiac catheterization
C) Echocardiogram
B)
Arterial blood gases
D) Swan-Ganz analysis
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
The echocardiogram is one of the most helpful diagnostic tools because the structure and
function of the ventricles can be observed easily. The ECG demonstrated dysrhythmias
and changes consistent with left ventricular hypertrophy. Cardiac catheterization, arterial
blood gases, and Swan-Ganz analysis would not be helpful in diagnosing
cardiomyopathy.
14.The nurse is preparing a patient for cardiac surgery. What procedure does the nurse
know is 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
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
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. This makes options B, C, and D incorrect.
15.A patient on the cardiac unit asks the nurse what the first symptoms of mitral stenosis
are. When discussing the clinical manifestations of mitral stenosis with this patient, it
would be important for the nurse to emphasize what?
A)
Palpable arterial pulsations
C) Difficulty breathing
Page 5
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
B)
New murmur
D) Mitral click
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion
as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to
show progressive fatigue as a result of low cardiac output. Palpable arterial pulsations
are present in aortic regurgitation. A mitral click is present in patients with mitral valve
prolapse. When a new murmur in patients with a systemic infection is found, infectious
endocarditis would be suspected.
16.You are caring for a patient who is scheduled to undergo a valvuloplasty to repair a
defective heart valve. You would include in your patient education which priority area?
A)
Patient controlled analgesia
C) Long-term steroid therapy
B)
Long-term anticoagulant therapy
D) Exercise program
Ans: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Feedback:
The nurse educates the patient about long-term anticoagulant therapy, explaining the
need for frequent follow-up appointments and blood laboratory studies. Long-term
steroid therapy is not a priority area of teaching for a patient who is scheduled for a
valvuloplasty. Patient control analgesia and an exercise program are not priorities for this
patient.
17.The staff educator is presenting a workshop on valvular disorders. When discussing the
pathophsiology of aortic regurgitation the educator points out the need to emphasize that
aortic regurgitation causes what?
A)
Cardiac tamponade
C) Right-sided heart failure
B)
Left ventricular hypertrophy
D) Ventricular insufficiency
Ans: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
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.
18.The nursing instructor is discussing cardiomyopathies with the junior nursing class. The
instructor asks the students to work through a plan of care for a patient with a
Page 6
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
A)
B)
cardiomyopathy. What priority outcomes does the instructor tell the students should be
included in the care plan for these patients?
Absence of complications
C) Improved cardiac output
Adherence to the self-care program D) Increased activity tolerance
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
The priority nursing diagnosis of a patient with cardiomyopathy would include improved
or maintained cardiac output. Regardless of the category and cause, cardiomyopathy
may lead to severe heart failure, lethal dysrthymias, 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
that improved cardiac output does.
19.You are receiving a patient with aortic regurgitation from the critical care unit into the
step-down unit. You are aware that aortic regurgitation causes what?
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
Ans: A
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
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.
20.When receiving a report of his assigned patients, the nurse learns that he is assigned to
care for a patient scheduled for a chordoplasty procedure. What is this procedure used to
do?
A)
Repair valve annulus
C) Repair chordae tendineae
B)
Repair leaflets
D) Repair the commissure
Ans: C
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Chordoplasty is a procedure to shorten, reattach, or elongate the chordae tendineae. It
does not repair leaflets, repair the annulus, or repair a commissure.
Page 7
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
Other possible complications include bleeding from the catheter insertion sites,
emboli resulting in complications such as strokes, and rarely, left-to-right atrial
shunts through an atrial septal defect caused by the procedure.
22.A patient with mitral valve stenosis is admitted to your unit. She is scheduled for surgery
to repair her valve. What procedure is usually performed to open the mitral valve?
A)
A valve replacement
C) Balloon valvuloplasty
B)
A chordoplasty
D) A commissurotomy
Ans: D
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
Surgical intervention consists of valvuloplasty, usually a commissurotomy to open or
rupture the fused commissures of the mitral valve. The other procedures are not
commonly used for mitral valve stenosis.
23.A patient is admitted to the CCU with a diagnosis of ischemic cardiomyopathy. What
does this diagnosis mean?
A)
An enlarged heart caused by CAD
B)
Dilation of the ventricles without simultaneous hypertrophy
C)
Rare autosomal dominant condition
D)
Diastolic dysfunction caused by rigid ventricular walls
Ans: A
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Feedback:
Ischemic cardiomyopathy is a term frequently used to describe an enlarged heart caused
by coronary artery disease, which is usually accompanied by heart failure. Therefore
options B, C, and D are incorrect.
24.A patient has been admitted with an aortic valve stenosis. The patient has been scheduled
for a balloon valvuloplasty in the cardiac cath lab later today. During the admission
assessment the patient tells the nurse he has thoracolumbar scoliosis and is concerned
about lying on the table in the cath lab for any period of time. What is a priority action
for the nurse?
Page 8
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
A)
B)
C)
D)
25.You are caring for a patient who had a percutaneous septal repair earlier today. Your
patient is awake and doing well. The patient asks you when she will get to go home.
What would be your best answer?
A)
Patients who had a percutaneous septal repair usually remain at the hospital for
12 to 18 hours.
B)
Patients who had a percutaneous septal repair usually remain at the hospital for
12 to 24 hours.
C)
Patients who had a percutaneous septal repair usually remain at the hospital for
24 to 36 hours.
D)
Patients who had a percutaneous septal repair usually remain at the hospital for
24 to 48 hours.
Ans: D
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Feedback:
After undergoing percutaneous septal repair, the patient usually remains in the hospital
for 24 to 48 hours. This makes options A, B, and C incorrect.
26.A patient is diagnosed with a septal defect. The physician talks with the patient about
options to close the defect. After the physician leaves the room the patient asks you
about closing the septal defect. What should you tell the patient?
A)
Many septal defects can be repaired percutaneously in a cardiac catheterization
laboratory.
B)
Repairing a septal defect is a dangerous procedure.
C)
Most septal defects need to be repaired through open heart surgery.
D)
I would have to think hard before deciding to have a septal defect repaired.
Ans: A
Cognitive Level: Comprehension
Difficulty: Moderate
Page 9
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
Page 10
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
A)
B)
Vasodilators
C) Calcium channel blockers
Diuretics
D) Antihypertensives
Ans: A
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Feedback:
Vasodilators are often prescribed first, to decrease resistance to ventricular ejection and
minimize the left-to-right shunting. Diuretics, calcium channel blockers, and
antihypertensives are not drugs of choice for patients with sepal defects.
30.You are caring for a patient in the cardiac ICU with a severe cardiomyopathy. This
patient's heart cannot pump adequate blood through the lungs or the body. What has this
patient been placed on to support their body until heart transplantation can be
performed?
A) ECHO B) An artificial heart C) ECMO D) An AAD
Ans: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
These more sophisticated ventricular assist devices (VADs) can circulate as much blood
per minute as the heart, if not more. Each VAD is used to support one ventricle. Some
VADs can be combined with an oxygenator; the combination is called extracorporeal
membrane oxygenation (ECMO). The oxygenatorVAD combination is used for the
patient whose heart cannot pump adequate blood through the lungs or the body. Option A
is only a distracter for this question. Options B and D are incorrect.
31.The nurse is teaching a patient diagnosed with aortic stenosis the importance of
attempting to relieve the symptom of angina without drugs. What would the nurse teach
the patient?
A)
To eat a small meal before taking nitroglycerin
B)
To drink a glass of milk before taking nitroglycerin
C)
To engage in 15 minutes of light exercise before taking nitroglycerin
D)
To rest and relax before taking nitroglycerin
Ans: D
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Feedback:
The venous dilation that results from nitroglycerin decreases blood return to the heart,
thus decreasing cardiac output and increasing the risk of syncope and decreased coronary
artery blood flow. The nurse teaches the patient about the importance of attempting to
relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and
to anticipate the potential adverse effects.
Page 11
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
Page 12
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
Page 13
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
Page 14
Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders
B)
C)
D)
E)
Page 15