CHECK FOR UNDERSTANDING (60 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be
given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in
you answer/ratio is not allowed. You are given 60 minutes for this activity:

Multiple Choice

1. A 20-year-old patient has acute infective endocarditis. While obtaining a nursing history, what
should the nurse ask the patient about (select all that apply)?

a. Renal dialysis
b. IV drug abuse
c. Recent dental work
d. Cardiac catheterization
e. Recent urinary tract infection

Answer: A B C D E
Rationale: recent dental, urologic, surgical, or gynecologic procedures and history of IV drug abuse,
heart disease, cardiac catheterization or surgery, renal dialysis, and infections all increase the risk of IE.

2. A patient has an admitting diagnosis of acute left-sided infective endocarditis. What is the best test
to confirm this diagnosis?
a. Blood cultures
b. Complete blood count
c. Cardiac catheterization
d. Transesophageal echocardiogram

Answer: A

Rationale: Although a complete blood cell count (CBC) will reveal a mild leukocytosis and erythrocyte
sedimentation rates (ESRs) will be elevated in patients with infective endocarditis, these are nonspecific
findings, and blood cultures are the primary diagnostic tool for infective endocarditis. Transesophageal
echocardiograms can identify vegetations on valves but are used when blood cultures are negative, and
cardiac catheterizations are used when surgical intervention is being considered.

3. Which manifestation of infective endocarditis is a result of fragmentation and microembolization of

Answer: A
Rationale: Petechiae may occur as a result of fragmentation and microembolization of vegetative lesions
and are common in the conjunctivae, the lips, the buccal mucosa, and the palate and over the ankles,
the feet, and the antecubital and popliteal areas.
4. What describes Janeway’s lesions that are manifestations of infective endocarditis?
a. Hemorrhagic retinal lesions
b. Black longitudinal streaks in nail beds
c. Painful red or purple lesions on fingers or toes
d. Flat, red, painless spots on the palms of hands and soles of feet

Answer: D
Rationale: Janeway’s lesions are flat, painless, small red spots found on the palms of the hands and the
soles of the feet. Black streaks on the nails are splinter hemorrhages. Hemorrhagic retinal lesions are
Roth’s spots. Painful lesions on the fingers and toes are Osler’s nodes

5. The patient with acute pericarditis is having a pericardiocentesis. Postoperatively what

Answer: B
Rationale: Pneumothorax may occur as a needle is inserted into the pericardial space to remove fluid for
analysis and relieve cardiac pressure with pericardiocentesis. Other complications could include
dysrhythmias, further cardiac tamponade, myocardial laceration, and coronary artery laceration

6. Priority Decision: A patient with acute pericarditis has a nursing diagnosis of pain related to
pericardial inflammation. What is the best nursing intervention for the patient?
a. Administer opioids as prescribed on an around-the-clock schedule.
b. Promote progressive relaxation exercises with the use of deep, slow breathing.
c. Position the patient on the right side with the head of the bed elevated 15 degrees.
d. Position the patient in Fowler’s position with a padded over-the-bed table for the patient to lean on.

Answer: D
Rationale: Relief from pericardial pain is often obtained by sitting up and leaning forward. Pain is
increased by lying flat. The pain has a sharp, pleuritic quality that changes with respiration and patients
take shallow breaths. Antiinflammatory medications may also be used to help control pain but opioids
are not usually indicated.

7. When obtaining a nursing history for a patient with myocarditis, what should the nurse specifically
question the patient about?
a. Prior use of digoxin for treatment of cardiac problems
b. Recent symptoms of a viral illness, such as fever and malaise
c. A history of coronary artery disease (CAD) with or without an MI
d. A recent streptococcal infection requiring treatment with penicillin
Answer: B
Rationale: Viruses are the most common cause of myocarditis in the United States and early
manifestations of myocarditis are often those of systemic viral infections. Myocarditis may also be
associated with systemic inflammatory and metabolic disorders as well as with other microorganisms,
drugs, or toxins. The patient with myocarditis is predisposed to drug-related dysrhythmias and toxicity
with digoxin, so it is used very cautiously, if at all, in treatment of the condition.

8. Priority Decision: What is the most important role of the nurse in preventing rheumatic fever?
a. Teach patients with infective endocarditis to adhere to antibiotic prophylaxis.
b. Identify patients with valvular heart disease who are at risk for rheumatic fever.
c. Encourage the use of antibiotics for treatment of all infections involving a sore throat.
d. Promote the early diagnosis and immediate treatment of group A streptococcal pharyngitis.

Answer: D
Rationale: Initial attacks of rheumatic fever and the development of rheumatic heart disease can be
prevented by adequate treatment of group A streptococcal pharyngitis. Because streptococcal infection
accounts for only about 20% of acute pharyngitis, cultures should be done to identify the organism and
direct antibiotic therapy. Viral infections should not be treated with antibiotics. Prophylactic therapy is
indicated in those who have valvular heart disease or have had rheumatic heart disease.

9. What manifestations most strongly support a diagnosis of acute rheumatic fever?

Answer: A
Rationale: Major criteria for the diagnosis of rheumatic fever include evidence of carditis, polyarthritis,
chorea (often very late), erythema marginatum, and subcutaneous nodules. Minor criteria include all
laboratory findings as well as fever, arthralgia, and a history of previous rheumatic fever. There also
must be evidence of a previous group A streptococci infection (e.g., positive antistreptolysin O titer).

10. A patient with rheumatic heart disease with carditis asks the nurse how long his activity will be
restricted. What is the best answer by the nurse?
a. “Full activity will be allowed as soon as acute symptoms have subsided.”
b. “Bed rest will be continued until symptoms of heart failure are controlled.”
c. “Nonstrenuous activities can be performed as soon as antibiotics are started.”
d. “Bed rest must be maintained until anti-inflammatory therapy has been discontinued.”

Answer: B
Rationale: When carditis is present in the patient with rheumatic fever, ambulation is postponed until
any symptoms of heart failure are controlled with treatment and full activity cannot be resumed until
antiinflammatory therapy has been discontinued. In the patient without cardiac involvement,
ambulation may be permitted as soon as acute symptoms have subsided and normal activity can be
resumed when antiinflammatory therapy is discontinued

11. The patient is admitted post–radiation therapy with symptoms of cardiomyopathy (CMP). Which
type of CMP should the nurse suspect that the patient is experiencing?
a. Dilated
b. Restrictive
c. Takotsubo
d. Hypertrophic

Answer: B
Rationale: A secondary cause of restrictive cardiomyopathy (CMP) is radiation treatment to the thorax
with stiffness of the ventricular wall occurring. Dilated CMP may have a genetic link, follow infectious
myocarditis, or be related to an autoimmune process or excess alcohol ingestion. Takotsubo CMP is an
acute stress-related syndrome that mimics acute coronary syndrome. It is most common in
postmenopausal women. Hypertrophic CMP has a genetic link in about one half of all cases and is
frequently seen in young athletic individuals

12. What accurately describes dilated CMP (select all that apply)?
a. Characterized by ventricular stiffness
b. The least common type of cardiomyopathy
c. The hyperdynamic systolic function creates a diastolic failure
d. Echocardiogram reveals cardiomegaly with thin ventricular walls
e. Often follows an infective myocarditis or exposure to toxins or drugs
f. Differs from chronic heart failure in that there is no ventricular hypertrophy

Answer: D E F
Rationale: d, e, f. Dilated CMP, the most common type of CMP, reveals cardiomegaly with thin
ventricular walls on echocardiogram, as there is no ventricular hypertrophy, and may follow an infective
myocarditis. As well, stasis of blood in the ventricles may contribute to systemic embolization.
Restrictive CMP is the least common type and is characterized by ventricular stiffness. Hypertrophic CMP
has hyperdynamic systolic function creating a diastolic failure, is characterized by massive thickening of
intraventricular septum and ventricular wall, and may result in syncope during increased activity
resulting from an obstructed aortic valve outflow

13. When planning care for the patient with hypertrophic CMP, what should the nurse include?
a. Ventricular pacing
b. Administration of vasodilators
c. Teach the patient to avoid strenuous activity and dehydration
d. Surgery for cardiac transplantation will need to be done soon

Answer: C
Rationale: Nursing interventions for the patient with hypertrophic CMP are to improve ventricular filling
by reducing ventricular contractility and relieving left ventricular outflow obstruction to relieve
symptoms and prevent complications. Strenuous activity and dehydration will increase systemic vascular
resistance and should be avoided. Atrioventricular pacing will allow the septum to move away from the
left ventricular wall and reduce the degree of outflow obstruction. Vasodilators may decrease venous
return and further increase obstruction of blood flow from the heart. The surgery that could be done
involves cutting into the thickened septal wall and removing some of the ventricular muscle

14. When performing discharge teaching for a patient with any type of CMP, what should the nurse
instruct the patient to do (select all that apply)?
a. Eat a low-sodium diet.
b. Go to the gym every day.
c. Engage in stress reduction activities.
d. Abstain from alcohol and caffeine intake.
e. Avoid strenuous activity and allow for periods of rest.
f. Suggest that caregivers learn cardiopulmonary resuscitation (CPR).

Answer: A C D E F
Rationale: a, c, d, e, f. These topics can apply to any patient with CMP.

15.A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which
information will the nurse plan to teach the patient about managing this disorder?
a. A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

Answer: D
Rationale: The patient should be instructed to notify the health care provider about any worsening of
heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even
patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of
the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with
hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider
heart transplantation.