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Brunner and Suddarths Medical Surgical Nursing 12th Edition Smeltzer Bare Hinkle Cheever Test Bank

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Brunner and Suddarths Medical Surgical Nursing 12th Edition Smeltzer Bare Hinkle Cheever Test Bank

ISBN-13: 978-0781785891

ISBN-10: 0781785898

 

Description

Brunner and Suddarths Medical Surgical Nursing 12th Edition Smeltzer Bare Hinkle Cheever Test Bank

ISBN-13: 978-0781785891

ISBN-10: 0781785898

 

 

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Import Settings:

Base Settings: Brownstone Default

Information Field: Chapter

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: E

Multiple Keywords in Same Paragraph: No

 

 

 

 

 

Chapter: Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

 

 

 

 

Multiple Choice

 

 

 

 

  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?
  2. A) Normal sinus rhythm
  3. B) Supraventricular tachycardia
  4. C) Atrial fibrillation
  5. D) Electromechanical dissociation

 

Ans:  C

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  800, Mitral Stenosis

 

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.

 

 

 

 

  1. 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?
  2. A) Otitis media
  3. B) Sepsis
  4. C) Bacterial endocarditis
  5. D) Deep vein thrombosis

 

Ans:  C

Chapter:  29

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  806, Nursing Management: Valvuloplasty and Replacement

 

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.

 

 

 

 

  1. A patient with hypertrophic cardiomyopathy has been admitted to your unit. What classification of medication do you know should be avoided in these patients?
  2. A) Antihypertensives
  3. B) Potassium supplements
  4. C) Diuretics
  5. D) Antiarrythmics

 

Ans:  C

Chapter:  29

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  813, Cardiomyopathy

 

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.

 

 

 

 

  1. You are caring for a postoperative heart transplant patient who is receiving azathioprine (Imuran). The patient asks you what this medication is for. What would your answer to this patient be?
  2. A) Azathioprine decreases the risk of thrombus formation.
  3. B) Azathioprine ensures adequate cardiac output.
  4. C) Azathioprine increases the number of white blood cells.
  5. D) Azathioprine minimizes rejection.

 

Ans:  D

Chapter:  29

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  811, Cardiomyopathy

 

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.

 

 

 

 

  1. 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.
  2. A) Enoxaparin (Lovenox)
  3. B) Metoprolol (Lopressor)
  4. C) Azathioprine (Imuran)
  5. D) Amoxicillin (Amoxil)

 

Ans:  D

Chapter:  29

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  816, Infective Endocarditis

 

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 high-risk patients immediately before and sometimes after certain procedures.

 

 

 

 

  1. 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?
  2. A) Palpitations
  3. B) Chest pain
  4. C) Burning sensation in chest
  5. D) Pounding heart rate

 

Ans:  B

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  819, Pericarditis

 

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.

 

 

 

 

  1. A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea as a result of pulmonary venous hypertension. What valvular disorder would cause pulmonary venous hypertension?
  2. A) Aortic regurgitation
  3. B) Mitral stenosis
  4. C) Mitral valve prolapse
  5. D) Aortic stenosis

 

Ans:  B

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  800, Mitral Stenosis

 

Feedback:  The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing.  Patients may expectorate blood (ie, hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.

 

 

 

 

  1. The nurse is caring for a patient who is scheduled for a balloon valvuloplasty. The nurse recalls that balloon valvuloplasty is most commonly used for which valvular heart disease?
  2. A) Aortic regurgitation
  3. B) Mitral valve prolapse
  4. C) Mitral stenosis
  5. D) Mitral regurgitation

 

Ans:  C

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  803, Valvuloplasty

 

Feedback:  Balloon valvuloplasty is most commonly used for patients diagnosed with mitral stenosis or aortic valve stenosis in elderly patients. For patients with mitral regurgitation, rotation of the great vessels, and thoracolumbar scoliosis, balloon valvuloplasty is contraindicated

 

 

 

 

  1. You are admitting a patient who has presented to the emergency room with dilated cardiomyopathy (DCM). What changes in the heart characterize DCM?
  2. A) Dilated ventricles with atrophy of the ventricles
  3. B) Dilated ventricles without hypertrophy of the ventricles
  4. C) Hypertrophy of the ventricles with no dilation of the ventricles
  5. D) Dilation of the atria and hypertrophy of the ventricles

 

Ans:  B

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  807, Cardiomyopathy

 

Feedback:  DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction.

 

 

 

 

  1. 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?
  2. A) Ultrasound of the heart
  3. B) Blood cultures
  4. C) ABG
  5. D) CBC

 

Ans:  B

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  816, Infective Endocarditis

 

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.

 

 

 

 

  1. 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?
  2. A) Recognizing and promptly treating streptococcal infections
  3. B) Adhering to antihypertenisve medication treatment
  4. C) Lowering blood cholesterol
  5. D) Smoking cessation

 

Ans:  A

Chapter:  29

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  5

Page and Header:  815, Rheumatic Endocarditis

 

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.

 

 

 

 

  1. 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?
  2. A) Prevent bacterial endocarditis
  3. B) Prevent inflammation of the urethra
  4. C) Avoid antibiotic use during the procedure
  5. D) Decrease need for surgical asepsis

 

Ans:  A

Chapter:  29

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  799, Mitral Valve Prolapse

 

Feedback:  Patients with mitral valve prolapse may be at risk for infectious endocarditis resulting 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.

 

 

 

 

  1. 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?
  2. A) Cardiac catheterization
  3. B) Arterial blood gases
  4. C) Echocardiogram
  5. D) Swan-Ganz analysis

 

Ans:  C

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  809, Cardiomyopathy

 

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.

 

 

 

 

  1. 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?
  2. A) Orthotropic transplant
  3. B) Xenograft
  4. C) Heterotropic transplant
  5. D) Homograft

 

Ans:  A

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  811, Cardiomyopathy

 

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.

 

 

 

 

  1. 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?
  2. A) Palpable arterial pulsations
  3. B) New murmur
  4. C) Difficulty breathing
  5. D) Mitral click

 

Ans:  C

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  800, Mitral Stenosis

 

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.

 

 

 

 

  1. 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?
  2. A) Patient controlled analgesia
  3. B) Long-term anticoagulant therapy
  4. C) Long-term steroid therapy
  5. D) Exercise program

 

Ans:  B

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  2

Page and Header:  806, Nursing Management: Valvuloplasty and Replacement

 

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.

 

 

 

 

  1. 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?
  2. A) Cardiac tamponade
  3. B) Left ventricular hypertrophy
  4. C) Right-sided heart failure
  5. D) Ventricular insufficiency

 

Ans:  B

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  801, Aortic Regurgitation

 

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.

 

 

 

 

  1. 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 cardiomyopathy. What priority outcomes does the instructor tell the students should be included in the care plan for these patients?
  2. A) Absence of complications
  3. B) Adherence to the self-care program
  4. C) Improved cardiac output
  5. D) Increased activity tolerance

 

Ans:  C

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  813, Cardiomyopathy

 

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.

 

 

 

 

  1. 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?
  2. A) Blood to flow back from the aorta to the left ventricle
  3. B) Obstruction of blood flow from the left ventricle
  4. C) Blood to flow back from the left atrium to the left ventricle
  5. D) Obstruction of blood from the left atrium to left ventricle

 

Ans:  A

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  801, Aortic Regurgitation

 

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.

 

 

 

 

  1. 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?
  2. A) Repair valve annulus
  3. B) Repair leaflets
  4. C) Repair chordae tendineae
  5. D) Repair the commissure

 

Ans:  C

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  802, Valvuloplasty

 

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.

 

 

 

 

  1. What procedure creates an atrial septal defect?
  2. A) Cardiac angiography
  3. B) CABG
  4. C) PTCA
  5. D) Ballon valvuloplasty

 

Ans:  D

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  803, Valvuloplasty

 

Feedback:  After a balloon valvuloplasty all patients have some degree of mitral regurgitation. 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.

 

 

 

 

  1. 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?
  2. A) A valve replacement
  3. B) A chordoplasty
  4. C) Balloon valvuloplasty
  5. D) A commissurotomy

 

Ans:  D

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  800, Mitral Stenosis

 

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.

 

 

 

 

  1. A patient is admitted to the CCU with a diagnosis of ischemic cardiomyopathy. What does this diagnosis mean?
  2. A) An enlarged heart caused by CAD
  3. B) Dilation of the ventricles without simultaneous hypertrophy
  4. C) Rare autosomal dominant condition
  5. D) Diastolic dysfunction caused by rigid ventricular walls

 

Ans:  A

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  807, Cardiomyopathy

 

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.

 

 

 

 

  1. 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?
  2. A) There is no need to do anything.
  3. B) Measure the degree of the curvature.
  4. C) Notify the surgeon immediately.
  5. D) Note the scoliosis on the intake assessment.

 

Ans:  C

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  2

Page and Header:  803, Valvuloplasty

 

Feedback:  Most often used for mitral and aortic valve stenosis, balloon valvuloplasty also has been used for tricuspid and pulmonic valve stenosis. The procedure is contraindicated for patients with left atrial or ventricular thrombus, severe aortic root dilation, significant mitral valve regurgitation, thoracolumbar scoliosis, rotation of the great vessels, and other cardiac conditions that require open heart surgery. Therefore notifying the physician would be the priority.

 

 

 

 

  1. 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?
  2. A) “Patients who had a percutaneous septal repair usually remain at the hospital for 12 to 18 hours.”
  3. B) “Patients who had a percutaneous septal repair usually remain at the hospital for 12 to 24 hours.”
  4. C) “Patients who had a percutaneous septal repair usually remain at the hospital for 24 to 36 hours.”
  5. D) “Patients who had a percutaneous septal repair usually remain at the hospital for 24 to 48 hours.”

 

Ans:  D

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  3

Page and Header:  807, Septal Defects

 

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.

 

 

 

 

  1. 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?
  2. A) “Many septal defects can be repaired percutaneously in a cardiac catheterization laboratory.”
  3. B) “Repairing a septal defect is a dangerous procedure.”
  4. C) “Most septal defects need to be repaired through open heart surgery.”
  5. D) “I would have to think hard before deciding to have a septal defect repaired.”

 

Ans:  A

Chapter:  29

Client Needs:  C

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  3

Page and Header:  807, Septal Defects

 

Feedback:  Many septal defects can be repaired percutaneously in a cardiac catheterization laboratory. A guidewire is advanced through a vein into the right side of the heart and through the septal defect. A special catheter is placed over the guidewire and positioned across the septal defect. Two connected mesh disks are then used to close the septal defect. Options B, C, and D are incorrect answers. Repairing a septal defect is no more dangerous than other cardiac surgeries.  Most septal defects do not need to be repaired through open heart surgery. Option D is a personal opinion and should not be used to respond to the question asked by the patient.

 

 

 

 

Multiple Selection

 

 

 

 

  1. The patient has just returned to the floor after a balloon valvuloplasty. The nurse caring for the patient knows that complications following this procedure include what? (Mark all that apply.)
  2. A) Emboli
  3. B) Mitral valve damage
  4. C) Ventricular dysrhythmia
  5. D) Atrial-septal defect
  6. E) Plaque formation

 

Ans:  A, B, C

Chapter:  29

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  803, Valvuloplasty

Feedback:  Possible complications include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, and bleeding from the catheter insertion sites. Atrial-septal defect and plaque formation are not complications of a balloon valvuloplasty.

 

 

 

 

Multiple Choice

 

 

 

 

  1. You are caring for a patient with right ventricular failure. What might have caused this diagnosis in your patient?
  2. A) Mitral valve regurgitation
  3. B) Aortic stenosis
  4. C) Aortic regurgitation
  5. D) Mitral valve stenosis

 

Ans:  D

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  800, Mitral Stenosis

 

Feedback:  Because there is no valve to protect the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails.

 

 

 

 

  1. You are the clinic nurse caring for a patient with a septal defect. Your new patient has just been prescribed medication to help minimize the left-to-right shunting. What class of drugs are often prescribed to help minimize the left-to-right shunting?
  2. A) Vasodilators
  3. B) Diuretics
  4. C) Calcium channel blockers
  5. D) Antihypertensives

 

Ans:  A

Chapter:  29

Client Needs:  D-2

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  807, Septal Defects

 

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.

 

 

 

 

  1. 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?
  2. A) ECHO
  3. B) An artificial heart
  4. C) ECMO
  5. D) An AAD

 

Ans:  C

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  812, Cardiomyopathy

 

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 oxygenator–VAD 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.

 

 

 

 

  1. 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?
  2. A) To eat a small meal before taking nitroglycerin
  3. B) To drink a glass of milk before taking nitroglycerin
  4. C) To engage in 15 minutes of light exercise before taking nitroglycerin
  5. D) To rest and relax before taking nitroglycerin

 

Ans:  D

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  802, Nursing Management: Valvular Heart Disorders

 

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.

 

 

 

 

  1. One of the cardiomyopathies is genetic. Which cardiomyopathy is autosomal dominant?
  2. A) Hypertrophic cardiomyopathy
  3. B) Restrictive cardiomyopathy
  4. C) Ventricular cardiomyopathy
  5. D) Dilated cardiomyopathy

 

Ans:  A

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  808, Cardiomyopathy

 

Feedback:  Hypertrophic cardiomyopathy is a rare autosomal dominant condition, occurring in men, women, and children (often detected after puberty) with an estimated prevalence rate of 0.05% to 0.2% of the population in the United States. The other options are not genetic in origin.

 

 

 

 

  1. You are caring for a patient newly diagnosed with cardiomyopathy. The patient asks you about the physiologic changes that accompany the diagnosis of cardiomyopathy. What would be important to stress about this disease process and what electrolyte imbalance it can lead to?
  2. A) Potassium
  3. B) Sodium
  4. C) Chloride
  5. D) Magnesium

 

Ans:  B

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  4

Page and Header:  807, Cardiomyopathy

 

Feedback:  The pathophysiology of all cardiomyopathies is a series of events that culminate in impaired cardiac output. Decreased stroke volume stimulates the sympathetic nervous system and the renin–angiotensin–aldosterone response, resulting in increased systemic vascular resistance and increased sodium and fluid retention, which places an increased workload on the heart. These alterations can lead to heart failure. This makes options A, C, and D incorrect.

 

 

 

 

  1. The nurse is caring for a patient with acute pericarditis. What nursing management would be instituted to minimize complications?
  2. A) The nurse keeps the patient isolated to prevent nosocomial infections.
  3. B) The nurse encourages coughing and deep breathing.
  4. C) The nurse helps the patient with activity restrictions until the pain and fever subside.
  5. D) The nurse encourages increased fluid intake until dehydration is resolved.

 

Ans:  C

Chapter:  29

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  819, Pericarditis

 

Feedback:  To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patient’s condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated; coughing and deep breathing are not encouraged; and an increase in fluid intake is not necessarily necessary.

 

 

 

 

  1. You are caring for a patient with myocarditis. You know that myocarditis can result from what comorbidity?
  2. A) Influenza B
  3. B) Strep throat
  4. C) Kidney disease
  5. D) HIV

 

Ans:  D

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  817, Myocarditis

 

Feedback:  Myocarditis usually results from viral (eg, coxsackievirus A and B, human immunodeficiency virus [HIV], influenza A), bacterial, rickettsial, fungal, parasitic, metazoal, protozoal (eg, Chagas disease), or spirochetal infection.

 

 

 

 

  1. You are on the infection control committee at your hospital. You are looking into three cases of hospital-acquired infective endocarditis among a specific classification of patient. What classification of patient is at risk for hospital-acquired endocarditis?
  2. A) Hemodialysis patients
  3. B) Patients on immunoglobulins
  4. C) Patients who need in and out catheterization
  5. D) Chemotherapy patients

 

Ans:  A

Chapter:  29

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  815, Infective Endocarditis

 

Feedback:  Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis. Patients on immunoglobulins, those who need in and out catheterization, and chemotherapy patients are not at increased risk for nosocomial infective endocarditis.

 

 

 

 

  1. You are caring for an Ethiopean refugee who has been diagnosed with mitral valve regurgitation. You know that in developing countries the most common cause of mitral valve regurgitation is what?
  2. A) A decrease in gamma globulins
  3. B) An insect bite
  4. C) Rheumatic heart disease and its sequelae
  5. D) Sepsis and its sequelae

 

Ans:  C

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  799, Mitral Regurgitation

 

Feedback:  The most common cause in developing countries is rheumatic heart disease and its sequelae. This makes options A, B, and D incorrect.

 

 

 

 

Multiple Selection

 

 

 

 

  1. Most people who have mitral valve prolapse never have any symptoms. Other patients with the diagnosis of mitral valve prolapsed do have symptoms. What symptoms might a patient have with mitral valve prolapse? (Mark all that apply.)
  2. A) Anxiety
  3. B) Fatigue
  4. C) Shoulder pain
  5. D) Hyperpnea
  6. E) Palpitations

 

Ans:  A, B, E

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  799, Mitral Valve Prolapse

Feedback:  Most people who have mitral valve prolapse never have symptoms. A few have symptoms of fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, and anxiety. Fatigue may occur regardless of activity level and amount of rest or sleep. Shortness of breath is not correlated with activity levels or pulmonary function. Atrial or ventricular dysrhythmias may produce the sensation of palpitations, but palpitations have been reported while the heart has been beating normally. Chest pain, which is often localized to the chest, is not correlated with activity and may last for days.  Anxiety may be a response to the symptoms; however, some patients report anxiety as the only symptom. Hyperpnea and shoulder pain are not symptoms of mitral valve prolapse.

 

 

 

 

Multiple Choice

 

 

 

 

  1. The patient has been told he needs an aortic annuloplasty. The surgeon explains to the patient that she will use the technique called leaflet plication. The patient asks you what a leaflet plication is? What would you respond to the patient?
  2. A) The elongated tissue is folded over onto itself and sutured.
  3. B) The leaflets are sutured to the pericardium.
  4. C) A wedge of tissue may be cut from the middle of the leaflet and the gap sutured closed.
  5. D) A pericardial or synthetic patch may be used to repair holes in the leaflets.

 

Ans:  A

Chapter:  29

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  2

Page and Header:  804, Valvuloplasty

 

Feedback:  The elongated tissue may be folded over onto itself (ie, tucked) and sutured (ie, leaflet plication). The other descriptions are not descriptions of leaflet plication.

 

 

 

 

Multiple Selection

 

 

 

 

  1. Signs and symptoms of restrictive cardiomyopathy are similar to those for constrictive pericarditis. What are the tests used to differentiate between cardiomyopathy and pericarditis? (Mark all that apply.)
  2. A) Cardiac ultrasonography
  3. B) Pulmonary artery wedge pressure
  4. C) Pulmonary artery systolic pressure
  5. D) Central venous pressure
  6. E) Echocardiography

 

Ans:  B, C, D, E

Chapter:  29

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  4

Page and Header:  808, Cardiomyopathy

Feedback:  Signs and symptoms are similar to those for constrictive pericarditis: dyspnea, nonproductive cough, and chest pain. Echocardiography, as well as measurement of pulmonary artery systolic (PAS) pressure, pulmonary artery wedge pressure (PAWP), and central venous pressure (CVP), are used to differentiate the two conditions. Cardiac ultrasonography is not diagnostic in this scenario.