Question 1

The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC).Which information obtained by the nurse is most important?

Accepted Answer

A)   The patient has a history of a recent upper respiratory infection.
B)   The patient has a family history of coronary artery disease (CA
D)  .
C)   The patient reports using cocaine a "couple of times" as a teenager.
D)   The patient's 29-year-old brother died from a sudden cardiac arrest. D

Question 2

While caring for a 23-year-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

Accepted Answer

A)   take antibiotics before any dental appointments.
B)   limit physical activity to avoid stressing the heart.
C)   take an aspirin a day to prevent clots from forming on the valve.
D)   avoid use of over-the-counter (OT
C)   medications that contain stimulant drugs. D

Question 3

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis.The priority intervention by the nurse for this problem is to

Accepted Answer

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)   remind the patient to request opioid pain medication every 4 hours.
D)   place the patient in Fowler's position, leaning forward on the overbed table. D

Question 4

Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are effective?

Accepted Answer

A)   Assess for the presence of a paradoxical pulse.
B)   Monitor for changes in the patient's sedimentation rate.
C)   Assess for the presence of jugular venous distention (JV
D)  .
D)   Check the electrocardiogram (ECG)  for ST segment changes.

Question 5

The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when a 30-year-old recovering from rheumatic fever without carditis says which of the following?

Accepted Answer

A)   "I will need prophylactic antibiotic therapy for 5 years."
B)   "I will need to take aspirin or ibuprofen (Motrin)  to relieve my joint pain."
C)   "I will call the doctor if I develop excessive fatigue or difficulty breathing."
D)   "I will be immune to further episodes of rheumatic fever after this infection."

Question 6

The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient?

Accepted Answer

A)   Patient admitted with a large acute myocardial infarction.
B)   Patient being discharged after an exacerbation of heart failure.
C)   Patient who had a mitral valve replacement with a mechanical valve.
D)   Patient being treated for rheumatic fever after a streptococcal infection.

Question 7

Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider?

Accepted Answer

A)   Pulsus paradoxus 8 mm Hg
B)   Blood pressure (BP)  of 168/94
C)   Jugular venous distention (JV
D)   to jaw level
D)   Level 6 (0 to 10 scale)  chest pain with a deep breath

Question 8

A 21-year-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?

Accepted Answer

A)   Biologic valves will require immunosuppressive drugs after surgery.
B)   Mechanical mitral valves need to be replaced sooner than biologic valves.
C)   Lifelong anticoagulant therapy will be needed after mechanical valve replacement.
D)   Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

Question 9

A patient with rheumatic fever has subcutaneous nodules,erythema marginatum,and polyarthritis.Based on these findings,which nursing diagnosis would be most appropriate?

Accepted Answer

A)   Pain related to permanent joint fixation
B)   Activity intolerance related to arthralgia
C)   Risk for infection related to open skin lesions
D)   Risk for impaired skin integrity related to pruritus

Question 10

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE).Which question by the nurse is most appropriate?

Accepted Answer

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?"

Question 11

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?

Accepted Answer

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 doctor about any symptoms of heart failure such as shortness of breath.

Question 12

To assess the patient with pericarditis for evidence of a pericardial friction rub,the nurse should

Accepted Answer

A)   listen for a rumbling, low-pitched, systolic murmur over the left anterior chest.
B)   auscultate by placing 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.

Question 13

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale)chest pain with deep breathing.Which ordered PRN medication will be the most appropriate for the nurse to give?

Accepted Answer

A)   Fentanyl 1 mg IV
B)   IV morphine sulfate 4 mg
C)   Oral ibuprofen (Motrin)  600 mg
D)   Oral acetaminophen (Tylenol)  650 mg

Question 14

The nurse is caring for a 78-year-old patient with aortic stenosis.Which assessment data obtained by the nurse would be most important to report to the health care provider?

Accepted Answer

A)   The patient complains of chest pressure when ambulating.
B)   A loud systolic murmur is heard along the right sternal border.
C)   A thrill is palpated at the second intercostal space, right sternal border.
D)   The point of maximum impulse (PMI)  is at the left midclavicular line.

Question 15

When caring for a patient with mitral valve stenosis,it is most important that the nurse assess for

Accepted Answer

A)   diastolic murmur.
B)   peripheral edema.
C)   shortness of breath on exertion.
D)   right upper quadrant tenderness.

Question 16

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)?

Accepted Answer

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

Question 17

After receiving report on the following patients,which patient should the nurse assess first?

Accepted Answer

A)   Patient with rheumatic fever who has sharp chest pain with a deep breath
B)   Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
C)   Patient with infective endocarditis who has a murmur and splinter hemorrhages
D)   Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

Question 18

Which action could the nurse delegate to unlicensed assistive personnel (UAP)trained as electrocardiogram (ECG)technicians working on the cardiac unit?

Accepted Answer

A)   Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome.
B)   Obtain a list of herbal medications used at home while admitting a new patient with pericarditis.
C)   Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy.
D)   Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

Question 19

The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation.Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately?

Accepted Answer

A)   The patient has bilateral crackles.
B)   The patient has bilateral, 4+ peripheral edema.
C)   The patient has a loud systolic murmur across the precordium.
D)   The patient has a palpable thrill felt over the left anterior chest.

Question 20

A patient is admitted to the hospital with possible acute pericarditis.The nurse should plan to teach the patient about the purpose of

Accepted Answer

A)   echocardiography.
B)   daily blood cultures.
C)   cardiac catheterization.
D)   24-hour Holter monitor.

Exam 33: Nursing Management: Inflammatory and Structural Heart Disorders

The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC) .Which information obtained by the nurse is most important?

While caring for a 23-year-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