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

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

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

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?
A) Normal sinus rhythm
B) Supraventricular tachycardia
C) Atrial fibrillation
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.

2. 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?

A) Otitis media
B) Sepsis
C) Bacterial endocarditis 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.

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

C) Diuretics
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.

4. 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?
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.

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.

5. 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.
A) Enoxaparin (Lovenox)
B) Metoprolol (Lopressor)

C) Azathioprine (Imuran) 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.

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