Chapter 29- Management of Patients With Structural,

Infectious, and

A)
B)

A)
B)

1. A nurse is
caring for a
patient with
mitral stenosis.
Based on the
pathophysiolog
y of this
disease
process, the
nurse would
expect the
patient to
exhibit which of
the following
heart rhythms?
Normal sinus
C)
rhythm
Supraventricula D)
r tachycardia
Ans: C
Difficulty: Mod
erate
2. Patients with
mitral stenosis
may be placed
on
anticoagulant
therapy. The
nurse knows
that this type of
therapy may be
instituted to
decrease the
risk of which of
the following?
Ventricular
C)
hypertrophy
Pulmonary
D)
embolism
Ans: D
Difficulty: Mod

Atrial fibrillation
Electromechani
cal dissociation

Deep vein
thrombosis
Atrial thrombus

erate

A)
B)

3. When
discussing the
pathophysiolog
y of aortic
regurgitation
with a patient,
the nurse
would
emphasize that
aortic
regurgitation
causes which of
the following?
Cardiac
C)
tamponade
Left ventricular D)
hypertrophy
Ans: B
Difficulty: Mod
erate

Right-sided
heart failure
Ventricular
insufficiency

4. When obtaining vital signs in a

patient with aortic regurgitation,
the nurse would expect which of
the following?
A) Widened pulse pressure B)
Hypotension C) Tachycardia
D) Bradypnea
Ans: A
Difficulty: Moderate
5. A nurse providing postoperative
teaching to a patient who has
received a valve replacement
discusses the importance of
antibiotic prophylaxis prior to any
dental or surgical procedure. The
nurse understands that antibiotic
prophylaxis prevents which of
the following in these patients?
A) Otitis media B) Sepsis C)
Bacterial endocarditis D) Deep
vein thrombosis

Ans: C
Difficulty: Moderate

A)
B)

A)

6. The nurse
caring for a
patient with
hypertrophic
cardiomyopath
y knows that
which of the
following
medication
classifications
should be
avoided?
Antihypertensiv C)
es
Potassium
D)
supplements
Ans: C
Difficulty: Mod
erate
7. A patient being
admitted to the
cardiac care
unit complains
of dyspnea on
exertion and
fatigue. His
ECG
demonstrates
dysrhythmias
associated with
left ventricular
hypertrophy.
Which of the
following
diagnostic tools
would be the
most helpful in
diagnosing
cardiomyopath
y?
Cardiac

C)

Diuretics
Antiarrhythmics

Echocardiogra

B)

A)
B)

catheterization
Arterial blood
gases
Ans: C
Difficulty: Mod
erate
8. The nurse
preparing a
patient for
cardiac surgery
knows that
which of the
following
procedures are
completed
when a
recipient's
heart is
removed and
the donor heart
is implanted at
the vena cava
and pulmonary
veins?
Orthotropic
transplant
Xenograft
Ans: A
Difficulty: Mod
erate
9. A postoperative
heart
transplant
patient is
receiving
azathioprine
(Imuran). The
nurse
understands
that this
medication is
used for which
of the

D)

C)
D)

m
Swan-Ganz
analysis

Heterotropic
transplant
Homograft

A)

B)

A)
B)

following?
Decreasing risk
of thrombus
formation
Ensuring
adequate
cardiac output
Ans: D
Difficulty: Mod
erate

C)

D)

10. When
discussing the
clinical
manifestations
of mitral
stenosis with a
patient on the
cardiac unit, it
would be
important for
the nurse to
emphasize
which of the
following as the
first symptom
of mitral
stenosis?
Palpable
C)
arterial
pulsations
New murmur
D)
Ans: C
Difficulty: Mod
erate
11. When assessing
a patient with
mitral
regurgitation,
the nurse
would expect
which of the
following heart

Increasing
number of
white blood
cells
Minimizing
rejection

Difficulty
breathing
Mitral click

A)
B)

A)
B)

sounds to
occur?
Diastolic
murmur
Systolic
murmur
Ans: B
Difficulty: Mod
erate

C)

Systolic click

D)

Ventricular
dysrhythmias

12. A patient is
undergoing a
valvuloplasty to
repair a
defective heart
valve. Patient
education is
aimed at which
of the following
priority areas of
teaching?
PatientC)
controlled
analgesia
Long-term
D)
anticoagulant
therapy
Ans: B
Difficulty: Mod
erate

Long-term
steroid therapy
Exercise
program

13. When discussing the

pathophysiology of
cardiomyopathy to a newly
diagnosed patient, it would be
important to stress that this
disease process can lead to
alterations in which of the
following electrolytes?
A) Sodium B) Potassium C)
Chloride D) Magnesium
Ans: A
Difficulty: Moderate
14. The nurse

A)
B)

A)
B)

developing a
plan of care for
a patient with
cardiomyopath
y should
include which
of the following
priority
outcomes?
Absence of
complications
Adherence to
the self-care
program
Ans: C
Difficulty: Mod
erate
15. The nurse
discussing
potential risk
factors of
infective
endocarditis
with a
hospitalized
patient would
include which
of the following
as a potential
risk factor of
this disease
process?
Radiation
exposure
Prosthetic
cardiac valves
Ans: B
Difficulty: Mod
erate
16. The nurse is
caring for a
patient with
rheumatic

C)
D)

C)
D)

Improved
cardiac output
Increased
activity
tolerance

Sedentary
lifestyle
Cardiac
catheterization

A)
B)

heart disease.
To prevent
bacterial
endocarditis,
the nurse
would expect
which of the
following
medications to
be prescribed
prior to any
type of dental
work.
Enoxaparin
(Lovenox)
Metoprolol
(Lopressor)
Ans: D
Difficulty: Mod
erate

C)
D)

Azathioprine
(Imuran)
Amoxicillin
(Amoxil)

17. When auscultating the breath

sounds of a patient with
pericarditis, the nurse would
expect to find which of the
following?
A) Rales B) Wheezes C)
Friction rub D) Rhonchi
Ans: C
Difficulty: Moderate

A)
B)

18. When assessing

a patient with
pericarditis, the
nurse should be
alerted to
which of the
following
symptoms of
the triad of
cardiac
tamponade?
Absence of pain C)
Decreasing

D)

Rising arterial
pressure
Distant heart

venous
pressure
Ans: D
Difficulty: Mod
erate

A)
B)

A)
B)

19. When assessing

a pericardial
friction rub, the
nurse knows
that this type of
sound has
which of the
following
characteristics?
Gallop
C)
Scratching or
D)
leathery sound
Ans: B
Difficulty: Mod
erate
20. The nurse is
caring for a
newly admitted
patient on the
telemetry unit.
The patient is
experiencing
progressive
fatigue,
hemoptysis,
and dyspnea as
a result of
pulmonary
venous
hypertension
due to which of
the following
valvular
disorders?
Aortic
C)
regurgitation
Mitral stenosis
D)
Ans: B

sounds

Whistling sound
Systolic click

Mitral valve
prolapse
Aortic stenosis

Difficulty: Diffic
ult

A)
B)
C)
D)

A)
B)
C)
D)

A)
B)
C)
D)

21. A patient with aortic

regurgitation is being transferred
from the critical care unit to the
step-down unit. The nurse
receiving the patient in the stepdown unit is aware that aortic
regurgitation causes:
Blood to flow back from the aorta
to the left ventricle
Obstruction of blood flow from
the left ventricle
Blood to flow back from the left
atrium to the left ventricle
Obstruction of blood from the left
atrium to the left ventricle
Ans: A
Difficulty: Moderate
22. The nurse caring for a patient
with aortic stenosis assesses for
which common symptom?
Angina pectoris
Palpable arterial pulsations in the
temporal arteries
Repeated respiratory infections
Orthopnea
Ans: A
Difficulty: Moderate
23. When teaching a patient about
his or her valvular heart disease,
the nurse instructs the patient to:
Use prophylactic antibiotic
treatment before dental work.
Avoid any activity.
Monitor weight biweekly.
Ignore advancing signs of
weakness because the disease
process is progressive.
Ans: A
Difficulty: Moderate

A)
B)

A)
B)

24. The nurse

caring for a
patient who is
scheduled for a
balloon
valvuloplasty
recalls that
balloon
valvuloplasty is
most commonly
used for which
valvular heart
disease?
Aortic
C)
regurgitation
Mitral valve
D)
prolapse
Ans: C
Difficulty: Mod
erate
25. Upon receiving
report of his
assigned
patients, the
nurse learns he
is assigned to
care for a
patient
scheduled for a
chordoplasty
procedure. This
procedure is
used to:
Repair valve
annulus
Repair leaflets
Ans: C
Difficulty: Mod
erate
26. Following an
implantation of

C)
D)

Mitral stenosis
Mitral
regurgitation

Repair chordae
tendineae
Repair the
commissure

A)
B)

a valve
prosthesis, the
nurse assesses
the patient for
the possible
complication of:
Heart failure
C)
Hypothermia
D)

Renal failure
Vasospasm of
the coronary
arteries

Ans: A
Difficulty: Mod
erate

A)
B)
C)
D)

27. The nurse is performing an

assessment on a patient who has
presented to the emergency
room with dilated
cardiomyopathy (DCM). Which of
the following changes in the
heart characterizes DCM?
Dilated ventricles with
hypertrophy of the ventricles
Dilated ventricles without
hypertrophy of the ventricles
Hypertrophy of the ventricles
with no dilation of the ventricles
Dilation of the atria and
hypertrophy of the ventricles
Ans: B
Difficulty: Difficult
28. Restrictive cardiomyopathy is
frequently first diagnosed when
the patient experiences:
A) Exertional dyspnea B)
Cardiac arrest C) Extreme
hunger D) Dehydration
Ans: A
Difficulty: Moderate
29. The nurse is reviewing diagnosis
studies for a patient admitted
with cardiomyopathy. What
diagnostic finding is consistent

A)
B)
C)
D)

A)
B)
C)
D)

with cardiomyopathy?
Hypotrophy of the heart on chest
radiograph
Normal endomyocardial biopsy
Minimal pulmonary blood flow
ECG changes showing left
ventricle hypertrophy
Ans: D
Difficulty: Moderate
30. A patient demonstrates an
adequate understanding of fluid
management associated with
congestion secondary to her
cardiomyopathy when she states:
I will need to increase my fluids
to 3 L/d to flush the fluids out of
my system.
I will need to restrict my fluids
to 2 L/d to decrease congestion.
I will need to restrict my fluids
to 2 L/d to decrease the chances
of developing a dysrhythmia.
I will need to restrict my fluids
to 2 L/d and increase my salt
intake.
Ans: B
Difficulty: Moderate
31. A treatment regimen is being
established for a patient with
endocarditis. To find the most
appropriate antibiotic treatment,
which of the following tests
would be the most helpful?
A) Ultrasound of the heart B)
Blood cultures C) ABG D)
CBC
Ans: B
Difficulty: Moderate
32. A community health nurse is
providing information to a group
of parents on rheumatic heart

disease. Which of the following is

the most effective prevention of
rheumatic heart disease?
Recognizing and prompting
treatment of streptococcal
infections
Adhering to antihypertensive
medication treatment
Lowering blood cholesterol
Smoking cessation
Ans: A
Difficulty: Moderate

A)
B)
C)
D)

A)
B)

A)
B)
C)
D)

33. The nurse

providing
discharge
teaching to a
patient
admitted with
pericarditis
informs him
that pericarditis
can lead to:
Scarring of the C)
mitral valve
Deformity of
the valve
leaflets
Ans: D
Difficulty: Mod
erate

D)

Inflammation of
the
endocardium
Pericardial
effusion

34. A patient with mitral valve

prolapse is scheduled to undergo
a cystoscopy. Gentamicin is
prescribed to be taken before the
procedure to:
Prevent bacterial endocarditis
Prevent inflammation of the
urethra
Avoid antibiotic use during the
procedure
Decrease the need for surgical
asepsis

Ans: A
Difficulty: Moderate