Chapter 24: Management of Patients with Structural, Infectious, and Inflammatory
Cardiac Disorders
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition
MULTIPLE CHOICE
1. A client with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology
of this disease process, the nurse would expect the client to exhibit which heart rhythm?
A. Ventricular fibrillation (VF)
B. Ventricular tachycardia (VT)
C. Atrial fibrillation
D. Sinus bradycardia
ANS: C
Rationale: In clients with mitral valve stenosis, the pulse is weak and often irregular because of atrial
fibrillation caused by strain on the atrium. Bradycardia, VF, and VT are not characteristic of this
valvular disorder.
PTS: 1 REF: p. 768
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
2. A client who has undergone a valve replacement with a mechanical valve prosthesis is due to be
discharged home. During discharge teaching, the nurse would discuss the importance of antibiotic
prophylaxis prior to which event?
A. Exposure to immunocompromised individuals
B. Future hospital admissions
C. Dental procedures
D. Live vaccinations
ANS: C
Rationale: 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.
PTS: 1 REF: p. 786
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Apply NOT: Multiple Choice
3. The critical care nurse is caring for a client who is receiving cyclosporine postoperative heart
transplant. What outcome represents a therapeutic outcome of this pharmacologic treatment?
A. The client remains free of thrombus formation.
B. The client maintains adequate cardiac output.
C. The client has an increase in white cell count.
D. The client does not experience organ rejection.
ANS: D
, Rationale: After heart transplant, clients are constantly balancing the risk of rejection with the risk of
infection. Most commonly, clients receive medications such as cyclosporine to minimize rejection.
Cyclosporine does not prevent thrombus formation, enhance cardiac output, or increase white cell
counts.
PTS: 1 REF: p. 779
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
4. A client with a history of rheumatic heart disease knows that the client is at risk for bacterial
endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should
ensure that the client knows the importance of taking which drug?
A. Enoxaparin
B. Metoprolol
C. Azathioprine
D. Amoxicillin
ANS: D
Rationale: Although rare, bacterial endocarditis may be life threatening. A key strategy is primary
prevention in high-risk clients (i.e., those with rheumatic heart disease, mitral valve prolapse, or
prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk clients immediately
before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other
listed drugs is an antibiotic.
PTS: 1 REF: p. 785
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
5. A client with pericarditis has just been admitted to the critical care unit. The nurse planning the client's
care should prioritize which 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
ANS: B
Rationale: 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.
PTS: 1 REF: p. 789
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
, 6. A client 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. Which valvular disorder would the nurse anticipate being diagnosed in this
client?
A. Aortic regurgitation
B. Mitral stenosis
C. Mitral valve prolapse
D. Aortic stenosis
ANS: B
Rationale: 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. Clients 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. Clients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea,
paroxysmal nocturnal dyspnea, and repeated respiratory infections. Pulmonary venous hypertension is
not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.
PTS: 1 REF: p. 768
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
7. The nurse is caring for a client with mitral stenosis who is scheduled for a balloon valvuloplasty. The
client reports being unsure of why the surgeon did not opt to replace the damaged valve rather than
repair it. Which statement indicates an advantage of valvuloplasty that the nurse should cite?
A. The procedure can be performed on an outpatient basis in a health care provider's office.
B. Repaired valves tend to function longer than replaced valves.
C. The procedure is not associated with a risk of infection.
D. Lower doses of antirejection drugs are required than with valve replacement.
ANS: B
Rationale: In general, valves that undergo valvuloplasty function longer than prosthetic valve
replacements and clients do not require continuous anticoagulation. Valvuloplasty carries a risk of
infection, like all surgical procedures, and it is not performed in a health care provider's office.
Antirejection drugs are unnecessary because foreign tissue is not introduced.
PTS: 1 REF: p. 771
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 24: Management of Clients with Structural, Infectious and Inflammatory Cardiac
Disorders KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
8. The nurse is reviewing the echocardiography results of a client who has just been diagnosed with
dilated cardiomyopathy (DCM). What changes in heart structure is this client experiencing?
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
ANS: B
Rationale: DCM is characterized by significant dilation of the ventricles without significant
concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in clients with DCM.
