Chapter 36: Inflammatory and Structural Heart Disorders

Chapter 36: Inflammatory and Structural Heart Disorders

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse obtains a health history from an older patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most focused on identifying a risk factor for IE?

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?”

 

 

ANS:  D

Dental procedures place the patient with a prosthetic mitral valve at risk for IE. Myocardial infarction, immunizations, and a family history of endocarditis are not risk factors for IE.

 

DIF:    Cognitive Level: Apply (application)           REF:               781

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

2. During the assessment of a young adult patient with infective endocarditis (IE), the nurse would expect to find

a.	substernal chest pressure.	c.	a pruritic rash on the chest.
b.	a new regurgitant murmur.	d.	involuntary muscle movement.

 

 

ANS:  B

New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.

 

DIF:    Cognitive Level: Understand (comprehension)                   REF:   790

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

3. 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)?

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

 

 

ANS:  B

Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output. Petechiae, fever, chills, and diaphoresis are symptoms of IE but are not caused by decreased cardiac output. An increase in pulse rate of 15 beats/min is normal with exercise.

 

DIF:    Cognitive Level: Apply (application)           REF:               780

TOP:   Nursing Process: Diagnosis              MSC:  NCLEX: Physiological Integrity

 

4. When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is most appropriate for the nurse to include?

a.	Arrange for placement of a long-term IV catheter.
b.	Monitor labs for levels of streptococcal antibodies.
c.	Teach the importance of completing all oral antibiotics.
d.	Encourage the patient to begin regular aerobic exercise.

 

 

ANS:  A

Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy to eradicate the bacteria, which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line. Rest periods and limiting physical activity to a moderate level are recommended during the treatment for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.

 

DIF:    Cognitive Level: Apply (application)           REF:               784

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity