MEDICAL SURGICAL NURSING CHAPTER 28

QUESTONS AND ANSWERS UPDATED. RATED

A+.

Chapter 28: Management of Patients With Structural, Infectious,

and Inflammatory Cardiac Disorders

1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the
pathophysiology of this disease process, the nurse would expect the patient to exhibit what
heart rhythm?

A) Ventricular fibrillation (VF)

B) Ventricular tachycardia (VT)

C) Atrial fibrillation

D) Sinus bradycardia

ANSWER: C

EXPLANATION:

In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial
fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.

2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is
due to be discharged home. During discharge teaching, the nurse should discuss the
importance of antibiotic prophylaxis prior to which of the following?

A) Exposure to immunocompromised individuals

B) Future hospital admissions

C) Dental procedures

D) Live vaccinations

ANSWER: C

EXPLANATION:
Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental
procedures involving manipulation of gingival tissue, the periapical area of the teeth or
perforation of the oral mucosa (not including routine anesthetic injections, placement of
orthodontic brackets, or loss of deciduous teeth). There are no current recommendations
around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to
people who are immunosuppressed.
3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit.
During the nurses admission interview, the patient states that she takes over-the-counter
water pills on a regular basis. How should the nurse best respond to the fact that the patient
has been taking diuretics?

A) Encourage the patient to drink at least 2 liters of fluid daily.

B) Increase the patients oral sodium intake.

C) Inform the care provider because diuretics are contraindicated.

D) Ensure that the patients fluid balance is monitored vigilantly.

ANSWER: C

EXPLANATION:

Diuretics are contraindicated in patients with HCM, so the primary care provider should be made
aware. Adjusting the patients sodium or fluid intake or fluid monitoring does not address this
important contraindication.

4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative
heart transplant. The patient asks the nurse to remind him what this medication is for. How
should the nurse best respond?

A) Azathioprine decreases the risk of thrombus formation.

B) Azathioprine ensures adequate cardiac output.

C) Azathioprine increases the number of white blood cells.

D) Azathioprine minimizes rejection of the transplant.

ANSWER: D

EXPLANATION:

After 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. Cyclosporine does not prevent thrombus formation, enhance cardiac output,
or increase white cell counts.

5. A patient with a history rheumatic heart disease knows that she is at risk for bacterial
endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse
should ensure that the patient knows the importance of taking which of the following drugs?

A) Enoxaparin (Lovenox)
B) Metoprolol (Lopressor)

C) Azathioprine (Imuran)

D) Amoxicillin (Amoxil)

ANSWER: D

EXPLANATION:

Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary

prevention in high-risk patients (i.e., 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. Amoxicillin is the drug
of choice. None of the other listed drugs is an antibiotic.

6. A patient with pericarditis has just been admitted to the CCU. The nurse planning the
patients care should prioritize what nursing diagnosis?

A) Anxiety related to pericarditis

B) Acute pain related to pericarditis

C) Ineffective tissue perfusion related to pericarditis

D) Ineffective breathing pattern related to

pericarditis ANSWER: B

EXPLANATION:

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. Anxiety is highly plausible and should be addressed, but chest pain is a nearly
certain accompaniment to the disease. Breathing and tissue perfusion are likely to be at risk,
but pain is certain, especially in the early stages of treatment.

7. A patient newly admitted to the telemetry unit is experiencing progressive fatigue,

hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms
are attributable to pulmonary venous hypertension. What valvular disorder should the nurse
anticipate being diagnosed in this patient?

A) Aortic regurgitation

B) Mitral stenosis
C) Mitral valve prolapse

D) Aortic stenosis

ANSWER: B

EXPLANATION:

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 (i.e., hemoptysis) or experience
palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory
infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation,
mitral valve prolapse, or aortic stenosis.

8. The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon
valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to
replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty
that the nurse should cite?

A) The procedure can be performed on an outpatient basis in a physicians office.

B) Repaired valves tend to function longer than replaced valves.

C) The procedure is not associated with a risk for infection.

D) Lower doses of antirejection drugs are required than with valve replacement.

ANSWER: B

EXPLANATION:

In general, valves that undergo valvuloplasty function longer than prosthetic valve
replacements and patients do not require continuous anticoagulation. Valvuloplasty carries a
risk of infection, like all surgical procedures, and it is not performed in a physicians office.
Antirejection drugs are unnecessary because foreign tissue is not introduced.

9. The nurse is reviewing the echocardiography results of a patient who has just been
diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure
characterize DCM?

A) Dilated ventricles with atrophy of the ventricles

B) Dilated ventricles without hypertrophy of the ventricles

C) Dilation and hypertrophy of all four heart chambers

D) Dilation of the atria and hypertrophy of the

ventricles ANSWER: B

EXPLANATION:

DCM is characterized by significant dilation of the ventricles without significant concomitant

hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.

10. A patient has been admitted to the medical unit with signs and symptoms suggestive of
endocarditis. The physicians choice of antibiotics would be primarily based on what diagnostic
test?

A) Echocardiography

B) Blood cultures

C) Cardiac aspiration

D) Complete blood count

ANSWER: B

EXPLANATION:

To help determine the causative organisms and the most effective antibiotic treatment for the
patient, blood cultures are taken. A CBC can help establish the degree and stage of infection,
but not the causative microorganism. Echocardiography cannot indicate the microorganisms
causing the infection. Cardiac aspiration is not a diagnostic test.

11. A community health nurse is presenting an educational event and is addressing several health
problems, including rheumatic heart disease. What should the nurse describe as the most
effective way to prevent rheumatic heart disease?

A) Recognizing and promptly treating streptococcal infections

B) Prophylactic use of calcium channel blockers in high-risk populations

C) Adhering closely to the recommended child immunization schedule

D) Smoking cessation

ANSWER: A

EXPLANATION:
 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, immunizations, and calcium channel blockers will not prevent rheumatic
heart disease.

12. A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to
investigate recent hemoptysis. The physician has ordered gentamicin to be taken before
the procedure. What is the rationale for this?

A) To prevent bacterial endocarditis

B) To prevent hospital-acquired pneumonia

C) To minimize the need for antibiotic use during the procedure

D) To decrease the need for surgical

asepsis ANSWER: A

EXPLANATION:

Antibiotic prophylaxis is recommended for high-risk patients immediately before and

sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would
not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to
decrease the need for surgical asepsis.

13. The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The
patients ECG shows dysrhythmias that are sometimes associated with left ventricular
hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy?

A) Cardiac catheterization

B) Arterial blood gases

C) Echocardiogram

D) Exercise stress test

ANSWER: C

EXPLANATION:

The echocardiogram is one of the most helpful diagnostic tools because the structure and
function of the ventricles can be observed easily. The ECG is also important, and can
demonstrate dysrhythmias and changes consistent with left ventricular hypertrophy. Cardiac
catheterization specifically addresses coronary artery function and arterial blood gases
evaluate gas exchange and acid balance. Stress testing is not normally used to differentiate
cardiomyopathy from other cardiac pathologies.
14. The nurse is preparing a patient for cardiac surgery. During the procedure, the patients
heart will be removed and a donor heart implanted at the vena cava and pulmonary veins.
What procedure will this patient undergo?

A) Orthotopic transplant

B) Xenograft

C) Heterotropic transplant

D) Homograft

ANSWER: A

EXPLANATION:

Orthotopic transplantation is the most common surgical procedure for cardiac transplantation.
The recipients heart is removed, and the donor heart is implanted at the vena cava and
pulmonary veins. Some surgeons still prefer to remove the recipients heart, leaving a portion
of the recipients atria (with the vena cava and pulmonary veins) in place. Homografts, or
allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for
aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not
terms used to describe heart transplantation.

15. A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient
during the nurses interview is most suggestive of this valvular disorder?

A) I get chest pain from time to time, but it usually resolves when I rest.

B) Sometimes when Im resting, I can feel my heart skip a beat.

C) Whenever I do any form of exercise I get terribly short of breath.

D) My feet and ankles have gotten terribly puffy the last few weeks.

ANSWER: C

EXPLANATION:

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. Palpitations occur in some patients, but
dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.

16. The nurse is caring for a patient who is scheduled to undergo mechanical valve
replacement. Patient education should include which of the following?
A) Use of patient-controlled analgesia

B) Long-term anticoagulant therapy

C) Steroid therapy

D) Use of IV diuretics

ANSWER: B

EXPLANATION:

Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids
are not indicated and patient-controlled analgesia may or may be not be used in the immediate
postoperative period.

17. The staff educator is presenting a workshop on valvular disorders. When discussing the
pathophysiology of aortic regurgitation the educator points out the need to emphasize that
aortic regurgitation causes what?

A) Cardiac tamponade

B) Left ventricular hypertrophy

C) Right-sided heart failure

D) Ventricular insufficiency

ANSWER: B

EXPLANATION:

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 nurse is creating a plan of care for a patient with a cardiomyopathy. What priority
goal should underlie most of the assessments and interventions that are selected for this
patient?

A) Absence of complications

B) Adherence to the self-care program

C) Improved cardiac output

D) Increased activity tolerance

ANSWER: C

EXPLANATION:

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 dysrhythmias, 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 of improved cardiac
output.

19. An older adult patient has been diagnosed with aortic regurgitation. What change in blood
flow should the nurse expect to see on this patients echocardiogram?

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 ANSWER: A

EXPLANATION:

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. A patient who has undergone valve replacement surgery is being prepared for discharge
home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the
nurse should educate the patient about which of the following?

A) The need for regularly scheduled testing of the patients International Normalized Ratio
(INR)

B) The need to learn to sleep in a semi-Fowlers position for the first 6 to 8 weeks to prevent
emboli

C) The need to avoid foods that contain vitamin K

D) The need to take enteric-coated ASA on a daily basis

ANSWER: A

EXPLANATION:

Patients who take warfarin (Coumadin) after valve replacement have individualized target INRs;
usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve
replacement. Natural sources of vitamin K do not normally need to be avoided and ASA is not
indicated. Sleeping upright is unnecessary.

21. A nurse is planning discharge health education for a patient who will soon undergo
placement of a mechanical valve prosthesis. What aspect of health education should the
nurse prioritize in anticipation of discharge?

A) The need for long-term antibiotics

B) The need for 7 to 10 days of bed rest

C) Strategies for preventing atherosclerosis

D) Strategies for infection

prevention ANSWER: D

EXPLANATION:

Patients with a mechanical valve prosthesis (including annuloplasty rings and other prosthetic
materials used in valvuloplasty) require education to prevent infective endocarditis. Despite
these infections risks, antibiotics are not used long term. Activity management is important, but
extended bed rest is unnecessary. Valve replacement does not create a heightened risk for
atherosclerosis.

22. A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To
minimize the patients symptoms, the nurse should teach the patient to do which of the
following?

A) Eat a high-protein, low-carbohydrate diet.

B) Avoid activities that cause an increased heart rate.

C) Avoid large crowds and public events.

D) Perform deep breathing and coughing exercises.

ANSWER: B

EXPLANATION:
 Patients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and
pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding
crowds is not usually necessary. Deep breathing and coughing are not likely to prevent
exacerbations of symptoms and increased protein intake is not necessary.

23. A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy.
When reviewing the patients most recent laboratory results, the nurse should prioritize
assessment of which of the following?

A) Sodium

B) AST, ALT, and bilirubin

C) White blood cell differential

D) BUN

ANSWER: A

EXPLANATION:

Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to
heart failure which develops, in part, from fluid overload. Fluid overload is often associated
with elevated sodium levels. Consequently, sodium levels are followed more closely than other
important laboratory values, including BUN, leukocytes, and liver function tests.

24. A patient has been admitted with an aortic valve stenosis and has been scheduled for a
balloon valvuloplasty in the cardiac catheterization lab later today. During the admission
assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned
about lying down for any extended period of time. What is a priority action for the nurse?

A) Arrange for an alternative bed.

B) Measure the degree of the curvature.

C) Notify the surgeon immediately.

D) Note the scoliosis on the intake assessment.

ANSWER: C

EXPLANATION:

Most often used for mitral and aortic valve stenosis, balloon valvuloplasty 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 over further physical
assessment. An alternative bed would be unnecessary and documentation is not a sufficient
response.

25. A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about
how this procedure will affect her busy work schedule. What guidance should the nurse
provide to the patient?

A) Patients generally stay in the hospital for 6 to 8 days.

B) Patients are kept in the hospital until they are independent with all aspects of their care.

C) Patients need to stay in the hospital until they regain normal heart function for their age.

D) Patients usually remain at the hospital for 24 to 48 hours.

ANSWER: D

EXPLANATION:

After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the
hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and
the patient does not need to be wholly independent prior to discharge.

26. A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has
read about numerous treatment options, including valvuloplasty. What should the nurse
teach the patient about valvuloplasty?

A) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.

B) Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well.

C) Valvuloplasty is open heart surgery, but this is very safe these days and normally
requires only an overnight hospital stay.

D) Its prudent to get a second opinion before deciding to have valvuloplasty.

ANSWER: A

EXPLANATION:

Some valvuloplasty procedures do not require general anesthesia or cardiopulmonary bypass

and can be performed in a cardiac catheterization laboratory or hybrid room. Open heart surgery
is not required and the procedure does not carry exceptional risks that would designate it as
being dangerous. Normally there is no need for the nurse to advocate for a second opinion.

The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the
27. nurse is planning appropriate assessments. The nurse should know that complications following
this procedure
 include what? Select all that apply.

A) Emboli

B) Mitral valve damage

C) Ventricular dysrhythmia

D) Atrial-septal defect

E) Plaque formation

ANSWER: A, B, C

EXPLANATION:

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.

28. The nurse is caring for a patient with right ventricular hypertrophy and consequently
decreased right ventricular function. What valvular disorder may have contributed to this
patients diagnosis?

A) Mitral valve regurgitation

B) Aortic stenosis

C) Aortic regurgitation

D) Mitral valve stenosis

ANSWER: D

EXPLANATION:

Because no valve protects 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. None of the other listed valvular disorders has this
pathophysiological effect.

29. The cardiac nurse is caring for a patient who has been diagnosed with dilated
cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological
finding?

A) Decreased ejection fraction

B) Decreased heart rate

C) Ventricular hypertrophy

D) Mitral valve regurgitation

ANSWER: A

EXPLANATION:

DCM is distinguished by significant dilation of the ventricles without simultaneous

hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased
ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in
patients with DCM.

30. A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football
practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of
cardiomyopathy is particularly common among young people who appear otherwise
healthy?

Dilated cardiomyopathy (DCM).

A)

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

B)

Hypertrophic cardiomyopathy (HCM)

C)

Restrictive or constrictive cardiomyopathy

D)

(RCM) ANSWER: C

EXPLANATION:

With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young
people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults
who appear otherwise healthy.

31. The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for
attempting to relieve the symptom of angina without drugs. What should 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

ANSWER: D

EXPLANATION:

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. Exercising, eating, and drinking are not recommended prior to using
nitroglycerin.

32. A patient has been living with dilated cardiomyopathy for several years but has experienced
worsening symptoms despite aggressive medical management. The nurse should
anticipate what potential treatment?

A) Heart transplantation

B) Balloon valvuloplasty

C) Cardiac catheterization

D) Stent placement

ANSWER: A

EXPLANATION:

When heart failure progresses and medical treatment is no longer effective, surgical
intervention, including heart transplantation, is considered. Valvuloplasty, stent placement, and
cardiac catheterization will not address the pathophysiology of cardiomyopathy.

33. A patient has undergone a successful heart transplant and has been discharged home with a
medication regimen that includes cyclosporine and tacrolimus. In light of this patients
medication regimen, what nursing diagnosis should be prioritized?

A) Risk for injury

B) Risk for infection

C) Risk for peripheral neurovascular dysfunction

D) Risk for unstable blood

glucose ANSWER: B

EXPLANATION:
 Immunosuppressants decrease the bodys ability to resist infections, and a satisfactory
balance must be achieved between suppressing rejection and avoiding infection. These drugs
do not create a heightened risk of injury, neurovascular dysfunction, or unstable blood
glucose levels.

34. The nurse is caring for a patient with acute pericarditis. What nursing management should be
instituted to minimize complications?

A) The nurse keeps the patient isolated to prevent nosocomial infections.

B) The nurse encourages coughing and deep breathing.

C) The nurse helps the patient with activities until the pain and fever subside.

D) The nurse encourages increased fluid intake until the infection resolves.

ANSWER: C

EXPLANATION:

To minimize complications, the nurse helps the patient with activity restrictions until the pain
and fever subside. As the patients condition improves, the nurse encourages gradual
increases of activity. Actions to minimize complications of acute pericarditis do not include
keeping the patient isolated. Due to pain, coughing and deep breathing are not normally
encouraged. An increase in fluid intake is not always necessary.

35. A patient who has recently recovered from a systemic viral infection is undergoing diagnostic
testing for myocarditis. Which of the nurses assessment findings is most consistent with
myocarditis?

A) Sudden changes in level of consciousness (LOC)

B) Peripheral edema and pulmonary edema

C) Pleuritic chest pain

D) Flu like symptoms

ANSWER: D

EXPLANATION:

The most common symptoms of myocarditis are flulike. Chest pain, edema, and changes in
LOC are not characteristic of myocarditis.

36. The nurse on the hospitals infection control committee is looking into two cases of hospital-
acquired infective endocarditis among a specific classification of patients. What classification
of patients would be at greatest risk for hospital-acquired endocarditis?
A) Hemodialysis patients

B) Patients on immunoglobulins

C) Patients who undergo intermittent urinary catheterization

D) Children under the age of 12

ANSWER: A

EXPLANATION:

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 children are not at increased risk for nosocomial infective endocarditis.

37. The nurse is caring for a recent immigrant who has been diagnosed with mitral valve
regurgitation. The nurse should know that in developing countries the most common cause of
mitral valve regurgitation is what?

A) A decrease in gamma globulins

B) An insect bite

C) Rheumatic heart disease and its sequelae

D) Sepsis and its sequelae

ANSWER: C

EXPLANATION:

The most common cause of mitral valve regurgitation in developing countries is rheumatic heart
disease and its sequelae.

Most individuals who have mitral valve prolapse never have any symptoms, although this is not
38. the case for every patient. What symptoms might a patient have with mitral valve prolapse?
Select all that apply.

A) Anxiety

B) Fatigue

C) Shoulder pain
D) Tachypnea

E) Palpitations

ANSWER: A, B, E

EXPLANATION:

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.
Hyperpnea and shoulder pain are not characteristic symptoms of mitral valve prolapse.

39. A cardiac surgery patients new onset of signs and symptoms is suggestive of cardiac
tamponade. As a member of the interdisciplinary team, what is the nurses most appropriate
action?

A) Prepare to assist with pericardiocentesis.

B) Reposition the patient into a prone position.

C) Administer a dose of metoprolol.

D) Administer a bolus of normal saline.

ANSWER: A

EXPLANATION:

Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will
not relieve the pressure on the heart and prone positioning would likely exacerbate
symptoms.

40. The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most
consistent with this diagnosis?

A) Wheezes

B) Friction rub

C) Fine crackles

D) Coarse crackles

ANSWER: B
EXPLANATION:

A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary
edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these
occurs with pericarditis.