Chapter 55: Management of Clients with Structural Cardiac Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 55: Management of Clients with Structural Cardiac Disorders

MULTIPLE CHOICE

1. The physician has expressed concern about the development of rheumatic fever in a client with a throat infection. The nurse would explain to the client that the organism causing the infection is

a.

a respiratory virus.

b.

beta-hemolytic streptococcus.

c.

Escherichia coli.

d.

Streptococcus pneumoniae.

ANS: B

Infections caused by beta-hemolytic streptococci are precursors to rheumatic fever.

DIF: Comprehension/Understanding REF: p. 1385 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse teaching a class on long-term effects of rheumatic fever would stress that the most common problem following bouts of rheumatic fever is

a.

cardiac tamponade.

b.

coronary artery disease.

c.

pericarditis.

d.

valvular disorders.

ANS: D

Valvular disorders are the most frequent complication after episodes of rheumatic fever.

DIF: Comprehension/Understanding REF: p. 1398 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. When performing cardiac auscultation on a client with mitral valve prolapse, the nurse would anticipate hearing a

a.

harsh, systolic murmur.

b.

loud S2 heart sound.

c.

midsystolic click.

d.

prominent S4 heart sound.

ANS: C

In a client with mitral valve prolapse, physical examination may reveal a regurgitant murmur, or a midsystolic click on auscultation.

DIF: Analysis/Analyzing REF: p. 1387 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. The nurse would explain to a client that the catabolism related to the hypermetabolic state caused by the clients rheumatic fever can be avoided by eating a

a.

high-carbohydrate, high-protein diet.

b.

high-fat, high-protein diet.

c.

high-protein, low-carbohydrate diet.

d.

high-protein, low-sodium diet

ANS: A

An enriched diet high in carbohydrates and protein will answer the bodys nutritional needs in the client with a hypermetabolic state induced by inflammatory processes and temperature elevation.

DIF: Comprehension/Understanding REF: p. 1400 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Hydration

5. The nurse would recognize that splinter hemorrhages in the nails, painful swollen nodules on the fingertips, and splenomegaly indicate

a.

infective endocarditis.

b.

mitral stenosis.

c.

mitral valve prolapse.

d.

pericarditis.

ANS: A

Clinical manifestations of embolization caused by infective endocarditis include splinter hemorrhages, Oslers nodes, finger clubbing, Janeways lesions, ocular signs, and splenomegaly.

DIF: Analysis/Analyzing REF: p. 1402 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

6. To help relieve the discomfort of a client with pericarditis who is experiencing pain, the nurse would position the client

a.

flat in bed.

b.

in semi-Fowlers position.

c.

prone.

d.

sitting upright.

ANS: D

The most characteristic subjective clinical manifestation of pericarditis is chest pain. Sitting up often relieves the pain.

DIF: Application/Applying REF: p. 1405 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Non-Pharmacological Comfort Measures

7. In the discharge teaching plan of a client with chronic myocarditis, the nurse would include the suggestion that

a.

family members should be screened for upper respiratory tract infection.

b.

family members should learn cardiopulmonary resuscitation (CPR).

c.

stairs in the home should be replaced with ramps.

d.

the client should not operate a motor vehicle.

ANS: B

The client should be taught about self-monitoring pertinent to heart rhythm, rate, and palpitations, and family members should be encouraged to take CPR training in case of an emergency.

DIF: Application/Applying REF: p. 1404 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

8. The nurse caring for a client with acute infective endocarditis would frequently assess for

a.

cardiac murmurs.

b.

elevation of blood pressure.

c.

pulse oximetry.

d.

urine output.

ANS: A

The nurse should auscultate every 8 hours for heart murmurs and assess for rapid pulse rate, easy fatigability, dyspnea, restlessness, manifestations of heart failure, and embolic manifestations in the client with infective endocarditis.

DIF: Application/Applying REF: p. 1403 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Illness Management

9. The change in vital signs that would most strongly suggest cardiac tamponade to the nurse is

a.

bradycardia.

b.

muffled heart sounds.

c.

narrowing pulse pressure.

d.

tachypnea.

ANS: C

Although muffled heart sounds indicate accumulation of fluid around the heart, narrowing pulse pressure signals cardiac tamponade.

DIF: Analysis/Analyzing REF: p. 1406 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

10. When a client is hospitalized with dilated cardiomyopathy, the nurse would examine the clients record for the characteristic history of

a.

long-term alcohol abuse.

b.

previous streptococcal infection.

c.

resistant hypertension.

d.

uncontrolled diabetes.

ANS: A

Risk of cardiomyopathy increases in clients who chronically ingest excessive amounts of alcohol (toxins). Other common causes are viral myocarditis, infections, metabolic problems, pregnancy, neuromuscular disorder, connective tissue disorders, and genetic predisposition. Some forms are idiopathic.

DIF: Application/Applying REF: p. 1393 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. The nurse auscultating heart sounds notes that a client has an opening snap and a low-pitched, rumbling murmur over the apex. This assessment would indicate

a.

aortic stenosis.

b.

mitral stenosis.

c.

pulmonic prolapse.

d.

tricuspid regurgitation.

ANS: B

The murmur characteristic of mitral stenosis is low pitched and rumbling and is preceded by an opening snap caused by the built-up pressure. It is heard best over the apex. The murmur of aortic stenosis is systolic and may be associated with a diminished second heart sound and early ejection click. The murmur of pulmonic prolapse is a crescendo-decrescendo, high-pitched diastolic blowing sound. Tricuspid regurgitation produces a holosystolic murmur heard best along the left sternal border.

DIF: Knowledge/Remembering REF: p. 1387 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. A client with mitral stenosis tells the nurse that she will not seek treatment for this disorder because she doesnt really feel that bad. The nurses best response would be that untreated mitral stenosis can result in

a.

creation of small emboli.

b.

frequent bouts of pericarditis.

c.

potentially fatal myocardial infarcts.

d.

pulmonary effusion.

ANS: A

Untreated mitral stenosis can progress from mild disability to severe disability in about 3 years. Ineffective atrial contractions allow some stagnation of blood in the left atrium and encourage the formation of mural thrombi. These thrombi easily break away and travel as small emboli in the arterial system, causing tissue infarction. Untreated, a client can progress from asymptomatic to having a severe disability in less than 10 years.

DIF: Comprehension/Understanding REF: pp. 1387-1388

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

13. In caring for a client considering mechanical mitral valve replacement, the essential determination for the nurse (and physician) to make would be whether the client can or will

a.

comply with the lifelong requirement for anticoagulant therapy.

b.

cooperate fully and participate in a cardiac rehabilitation program.

c.

experience body image problems from the sternal scar.

d.

require a high level of physical energy at work.

ANS: A

Clients with mechanical valves require continuous anticoagulation therapy for the remainder of their lives. A client who cannot tolerate or cooperate with this regimen might be considered for a tissue valve.

DIF: Analysis/Analyzing REF: p. 1392 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Compliance with Treatment Regimen

14. For a client who has undergone a tissue valve replacement, the most appropriate anticipatory guidance provided by the nurse would be

a.

activity should be restricted to reduce stress on the valve.

b.

follow-up is important, since most tissue valves eventually need replacement.

c.

long periods of standing decreases venous return to the heart.

d.

modification of lifestyle can prevent associated dysrhythmias.

ANS: B

The mechanical valves are very durable but require anticoagulant therapy; the tissue valves may not require anticoagulant therapy but are less durable. Almost every client with a tissue valve will require replacement.

DIF: Application/Applying REF: p. 1392 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

15. In counseling a client who is considering a heart transplant, the nurse would know the client has an accurate perception of this treatment option when the client says

a.

Less than half of those who survive a heart transplant live 10 years.

b.

People under 75 years of age may have a heart transplant.

c.

The survival rate for patients having a heart transplant is about 80%.

d.

This is an experimental treatment, but I want to take the chance.

ANS: C

Cardiac transplantation is now a standard and effective treatment for clients with end-stage cardiac disease. Currently, 84% of heart transplant patients survive 1 year, and 77% survive 3 years. Selection criteria include age less than 65 years.

DIF: Evaluation/Evaluating REF: p. 1395 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Illness Management

16. The nurse would stress in a discharge teaching plan for a client recovering from endocarditis that to avoid further complication, the client should

a.

become actively involved in social and community activities.

b.

drink at least 1000 ml of fluid daily to ensure adequate hydration.

c.

initiate a comprehensive daily exercise program.

d.

notify the physician when invasive dental procedures are planned.

ANS: D

Clients recovering from endocarditis should take special precaution by contacting the physician for extra antibiotic coverage when invasive dental procedures are scheduled.

DIF: Application/Applying REF: pp. 1403, 1404

OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

17. For a client waiting for a heart transplant who has been fitted with a left ventricular assist device (LVAD), the nurse would explain that the purpose of this device is to

a.

electrically stimulate the left ventricle to contract.

b.

extract blood from the left ventricle and propel it into the systemic circulation.

c.

measure hemodynamics of cardiac output occurring because of dysrhythmias.

d.

sound an alarm when the intraventricular pressure drops.

ANS: B

The LVAD helps support the dangerously impaired heart while the client is waiting for a donor heart by extracting blood from the left ventricle and propelling it into the systemic circulation.

DIF: Comprehension/Understanding REF: p. 1397 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

18. A client has dilated cardiomyopathy and is angry and irritable to all the nursing staff. When planning care for this client, which nursing diagnoses would be the priority to address this problem?

a.

Altered Body Image

b.

Hopelessness

c.

Impaired Verbal Communication

d.

Risk for Non-compliance

ANS: B

Clients with dilated cardiomyopathy require strong psychological support. The chronic and progressive nature of this illness deplete coping resources, leaving many clients feeling helpless, hopeless, and frustrated. As the disease progresses, they may have feelings of inadequacy and poor self-esteem. They may become angry, irritable, withdrawn, or overly dependent.

DIF: Analysis/Analyzing REF: p. 1395 OBJ: Diagnosis

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

19. To encourage a client recovering from endocarditis, the nurse would stress that new guidelines for home care are less restrictive than in the past and the client no longer needs to

a.

observe complete bed rest.

b.

restrict the amount of activity.

c.

take 2 to 5 weeks of antibiotic therapy.

d.

take precautions against emboli formation.

ANS: A

The client recovering from endocarditis is no longer restricted to bed rest unless there is evidence of fever or heart damage. Antibiotic therapy, limited activity, and precautions against emboli are still part of the recovery protocol.

DIF: Comprehension/Understanding REF: p. 1403 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

20. Examining the electrocardiogram strips of a client with mitral stenosis, the nurse would recognize the characteristic dysrhythmia of

a.

atrial fibrillation.

b.

artial flutter.

c.

sinus tachycardia.

d.

ventricular tachycardia.

ANS: A

Atrial fibrillation is a dysrhythmia that frequently develops as a result of mitral stenosis.

DIF: Analysis/Analyzing REF: p. 1387 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Illness Management

21. When the client with rheumatic fever becomes irritable and impatient with the restrictions of the disease, the home health nurse would remind the client that manifestations of rheumatic fever usually abate in about

a.

3 months.

b.

6 months.

c.

9 months.

d.

1 year.

ANS: A

The manifestations of rheumatic fever usually abate within 3 months of onset.

DIF: Comprehension/Understanding REF: p. 1398 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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