(Osborn) Chapter 41: Learning Outcomes (Number and Title)

[Osborn] chapter 41
Learning Outcomes [Number and Title]

Learning Outcome 1
Compare and contrast the etiology, pathophysiology, clinical
manifestations, and medical and nursing management for the
four inflammatory/infectious disorders.
Learning Outcome 2
Integrate the etiology, pathophysiology, clinical manifestations,
and treatment for valve stenosis, regurgitation, and mitral valve
prolapse.
Learning Outcome 3
Explain the rationale and type of preventive therapy necessary
for patients with valve disease.
Learning Outcome 4
Differentiate valve repair and replacement procedures in terms
of patient care and education needs.
Learning Outcome 5
Compare and contrast the four types of cardiomyopathy in
terms of etiology,
Learning Outcome 6
Apply nursing diagnoses and the nursing process to the care of
the patient with inflammatory and structural heart disease.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. Cardiac tamponade is suspected in a client who has undergone a repair of a ventricular

aneurysm. What assessment data would assist the nurse in determining the presence of
cardiac tamponade?
1. The distance in mm's of Hg between the Korotkoff sounds during inspiration,

while taking the blood pressure
2. The rhythm of the pulse in relation to the client's inspiration and expiration
3. Arterial blood gases
4. A cardiac murmur that occurs during systole
Correct Answer: The distance in mm's of Hg between the Korotkoff sounds during
inspiration, while taking the blood pressure
Rationale: A pulses paradox is an important diagnostic clue when evaluating for the
presence and progression of cardiac tamponade. It is defined as a greater than 10-mm
drop in systolic blood pressure (BP) during inspiration. The BP normally decreases
during inspiration, but it is less than 10 mmHg. A paradox of greater than 10 mmHg is
present when there is increased thoracic pressure, which is due to pericardial swelling.
There is normally no difference in the rhythm of the pulse during inspiration and
expiration. Arterial blood gases changes and the presence of cardiac murmurs are not
specific to cardiac tamponade.
Cognitive Level: Synthesis
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 1
2. The nurse implements the following measures for a client with rheumatic fever: turn,
cough, deep breath, elevate head of bed, instruct on use of incentive spirometry. Upon
which parameters would the nurse assess the effectiveness of the nursing interventions?
Select all that apply.
1.
2.
3.
4.
5.
Arterial blood gases

Lung sounds
Orientation
Urine output
Potassium level
Correct Answer:
1. Arterial blood gases
2. Lung sounds
3. Orientation
Rationale: Arterial blood gases. The outcome of the nursing measures is adequate gas
exchange. Arterial blood gases are evaluation parameters used when assessing gas
exchange. Lung sounds. The outcome of the nursing measures is adequate gas exchange.
Lung sound evaluation parameters are used when assessing gas exchange. Orientation.
The outcome of the nursing measures is adequate gas exchange. The clients orientation
is an evaluation parameter used when assessing gas exchange. Urine output. Urine
output is not a gas exchange parameter. Potassium level. Potassium level is not a gas
exchange parameter.
Cognitive Level: Synthesi
Nursing Process: Assessment, Implementation
Client Need: Physiological Integrity
LO: 1
3. Pain is associated with inflammatory heart disease. What interventions should be

included in the best management plan to keep the client pain-free?
1.
2.
3.
4.
5.
Instruct client to inform nurse if pain is not relieved.

Provide a supportive environment where client is able to express pain level.
Instruct the client that there is a risk of addiction and overdose.
Medicate the client only when the pain is severe.
Have the family manage the clients pain.
Correct Answer:
1. Instruct client to inform nurse if pain is not relieved.
2. Provide a supportive environment where client is able to express pain level.
Rationale: Instruct client to inform nurse if pain is not relieved. Pain relief is the
nursing goal; therefore, it is essential that the client communicates with the nurse about
the effectiveness of the pain control measures. Provide a supportive environment
where client is able to express pain level. The nurse must provide an environment
where the client feels comfortable and supported in order to have effective
communication and attain the pain-free goal. Instruct the client that there is a risk of
addiction and overdose. The nurse needs to assure the client that the risk of addiction is
not a consideration with short-term narcotic use. Medicate the client only when the
pain is severe. An effective pain relief measure is to medicate as soon as the pain begins,
as it increases comfort and decreases need for medication. Have the family manage the
clients pain. It is inappropriate to have the family manage the pain. It is the
responsibility of the health care provider and the nurse.
Cognitive Level: Evaluation
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 1
4. Clients with stenosed heart valves will have problems with __________ flow of blood,
and those with regurgitant incompetent heart valves will have problems with _________
flow of blood.
1.
2.
3.
4.
Forward; backward
Forward; forward
Backward; forward
Backward; backward
Correct Answer: Forward; backward

Rationale: A stenotic valve has a narrowed orifice that does not allow blood to flow
normally into the next chamber. A regurgitant valve does not close properly; therefore
blood backs up into the previous chamber. Both conditions decrease cardiac output.
Cognitive Level: Analysis
LO: 2
5. While caring for a client with severe aortic stenosis, the nurse understands that limited
activity is essential to prevent fatigue. Which of the following instructions is (are)
appropriate?
1.
2.
3.
4.
5.
Discontinue activity if chest pain or shortness of breath occurs.

Explore sedentary activities.
Maintain balanced nutrition to ensure adequate caloric intake.
Administer humidified oxygen as prescribed.
Follow a progressive activity schedule that increases activity level by 10%
each week.
Correct Answer:
1. Discontinue activity if chest pain or shortness of breath occurs.
2. Explore sedentary activities.
3. Maintain balanced nutrition to ensure adequate caloric intake.
Rationale: Discontinue activity if chest pain or shortness of breath occurs. It is
important to have an activity plan that prevents fatigue. Teaching the client when to
stop activities is essential in preventing extra workload on the heart and fatigue.
Explore sedentary activities. Exploring sedentary activities that the client enjoys
will help decrease cardiac workload. Maintain balanced nutrition to ensure
adequate caloric intake. Well-balanced nutrition will provide the needed calories for
energy expenditure. Administer humidified oxygen as prescribed. Activity that
would require oxygen is too strenuous. Follow a progressive activity schedule
that increases activity level by 10% each week. A progressive activity plan would
not be feasible with severe aortic stenosis.
LO: 2
6. Following valve replacement surgery, the client is taught that if fever, increased heart
rate, fatigue, malaise, anorexia, weight loss, headache, chills, and/or night sweats occur, the
client needs to notify the health care provider, as this is as a sign of:
1. Infective endocarditis.
2. Myocardial infarction.
3. Valve rejection.
4. Heart failure.
Correct Answer: Infective endocarditis.
Rationale: The clinical manifestations are a sign of postoperative infective endocarditis,
which needs immediate medical attention. Myocardial infarction is typically manifested
with angina, ECG changes, and an increase in cardiac laboratory tests. Replacement
valves are not vascular; therefore rejection does not occur. Heart failure is manifested
with lung congestion and shortness of breath.
LO: 2
7. As the nurse, you are developing a discharge plan for a client who has had valve
replacement surgery and is on warfarin. You know the client understands the plan when
she states:
1. I need to report bruising, bleeding, epistaxis, and hemoptysis to my health
care provider.
2. I need to eat large amounts of yellow and dark green vegetables.
3. I should take aspirin and anti-inflammatory drugs (NSAIDs) for pain.
4. I should avoid red meat.
Correct Answer: I need to report bruising, bleeding, epistaxis, and hemoptysis to my
health care provider.
Rationale: Bruising, bleeding, epistaxis, and hemoptysis are all signs of abnormal
bleeding, which may indicate that a change is needed to the warfarin dosage. Yellow and
green vegetables should be avoided due to the vitamin K content, which counteracts the
warfarin. Aspirin and NSAIDs also cause bleeding and would be contraindicated while
taking warfarin. Red meat has no significance for this client.
LO: 3
8. The client with mitral regurgitation is instructed to report to the health care provider when
it is becoming too difficult to perform activities of daily living because this is an
indication:
1. That it is time for valve replacement.
2. Of infective endocarditis.
3. Of a myocardial infarction.
4. Of acute respiratory distress.
Correct Answer: That it is time for valve replacement.

Rationale: The clients ability to perform activities of daily living is used as the indicator
of when it is time to replace the valve. The goal is to replace the valve before there is
permanent left ventricular damage. Since valves wear out over time, it is essential to wait
as long as possible. Ability to perform activities of daily living is not used when assessing
for myocardial infarction, infective endocarditis, or respiratory distress.
LO: 3
9. The nurse is admitting a client with a sudden onset of dyspnea and a blowing highpitched murmur. The nurse understands that these are typical clinical manifestations of:
1. Acute mitral valve regurgitation.
2. Acute mitral valve stenosis.
3. Aortic stenosis.
4. Mitral valve prolapse.
Correct Answer: Acute mitral valve regurgitation.
Rationale: The sudden onset of symptoms indicates it is an acute problem. The dyspnea
and blowing high-pitched murmur are classic clinical manifestations of mitral valve
regurgitation. Chronic valve disorders have a gradual onset of symptoms. Mitral valve
stenosis has a low-pitched, rumbling, crescendo-decrescendo diastolic murmur. Aortic
stenosis has a harsh crescendo-decrescendo systolic murmur. Mitral valve prolapse has a
mid-systolic to late-systolic click heard between S1 and S2.
LO: 3
10. The nurse is admitting a client who is scheduled for a valvular annuloplasty. The
client asks why she needs her valve replaced. What are the most appropriate
responses?
1. You are not having the valve replaced; you are having the fibrous ring at the
junction of the valve leaflets and the muscular wall repaired.
2. Have you asked your surgeon this question?
3. You are having your valve replaced because it is diseased.
4. Due to valve stenosis, the valve leaflets must be separated.
5. Your family has been informed of the procedure.
Correct Answer:
1. You are not having the valve replaced; you are having the fibrous ring at the
junction of the valve leaflets and the muscular wall repaired.
2. Have you asked your surgeon this question?
Rationale: You are not having the valve replaced; you are having the fibrous ring
at the junction of the valve leaflets and the muscular wall repaired. An annuloplasty
is a repair procedure, not a valve replacement surgery, that is for valve regurgitation, not
stenosis. Have you asked your surgeon this question? The client needs to talk to the
surgeon in order to have informed consent before surgery. You are having your valve
replaced because it is diseased. Telling the client that the valve is being replaced is
inaccurate. Due to valve stenosis, the valve leaflets must be separated. This client
does not have valve stenosis, she has regurgitation. Your family has been informed of
the procedure. This is inappropriate because in order for the client to sign for the
surgery, she must understand the procedure in order to have informed consent.
LO: 4
11. Due to the chronic and progressive nature of cardiac valve disease, a
collaborative care approach is optimal for client management. What member of the
team would be essential to a holistic approach to client care?

1.
2.
3.
4.
5.
Nurses and health care providers

Physical and occupational therapists
Psychologists/psychiatrists
Dieticians
Pharmacists
Correct Answer:
1. Nurses and health care providers
2. Physical and occupational therapists
3. Psychologists/psychiatrists
4. Dieticians
5. Pharmacists
Rationale: Nurses and health care providers. Nurses are pivotal in the coordination of
the health care team and nursing management. It is essential that the health care provider
monitor the progress of the valve disease and determine when surgical intervention is
necessary. Physical and occupational therapists. The occupational therapist helps
facilitate realistic occupational goals, while the physical therapist assists in the
maintenance of optimum conditioning given the activity restrictions.
Psychologists/psychiatrists. Psychiatric counseling may be necessary to assist in
lifestyle adjustments necessitated by a chronic disease process. Dieticians. When cardiac
valve disease is complicated by the presence of heart failure symptoms of congestion,
diet and fluid restriction counseling are necessary. The dietician can educate the
client/family about salt restrictions and assist them to have satisfying meals that do not
increase the risk of fluid retention. Pharmacists. Since medication is an essential part of
the management of valve disorders, the role of the pharmacist is crucial in educating the
client about how to manage the medications and their side effects.
LO: 4
12. While teaching a client about her pending valve replacement surgery, the nurse
explains that the main differences between biological valves and mechanical
valves are that:
1. Biological valves have a decreased incidence of clot formation as opposed to
mechanical valves.
2. Biological valves wear out faster than mechanical valves.
3. Biological valves have an increased incidence of clot formation as opposed to
mechanical valves.
4. Mechanical valves wear out faster than biological valves.
Correct Answer:
1. Biological valves have a decreased incidence of clot formation as opposed to
mechanical valves.
2. Biological valves wear out faster than mechanical valves.
Rationale: Biological valves have a decreased incidence of clot formation as opposed
to mechanical valves. Mechanical valves have an increased incidence of clot formation
as opposed to biological valves. Biological valves wear out faster than mechanical
valves. Mechanical valves wear out more slowly than biological valves. Biological
valves have an increased incidence of clot formation as opposed to mechanical
valves. Biological valves have a decreased incidence of clot formation as opposed to
mechanical valves. Mechanical valves wear out faster than biological valves.
Biological valves wear out faster than mechanical valves.
LO: 4
13. While taking a nursing history of a client recently diagnosed with restrictive
cardiomyopathy, which information does the nurse recognize as significant to his health
problem?
1.
2.
3.
4.
A history of living in Europe

A family history of cardiomyopathy
Excessive alcohol use
History of depression
Correct Answer: A history of living in Europe

Rationale: The most common cause of restrictive cardiomyopathy is from a parasitic
infection that is seen primarily in Africa, Europe, and India. A family history of
cardiomyopathy is most common with hypertrophic obstructive cardiomyopathy.
Excessive alcohol use is associated with dilated cardiomyopathy. Depression is not
related to the cause of cardiomyopathy.
LO: 5
14. When assessing a client with dilated cardiomyopathy, the nurse understands that the
most common clinical manifestation is___________ due to______________.
1.
2.
3.
4.
Dyspnea; bronchial compression

Cyanosis; decreased oxygenation
Peripheral edema; decreased renal perfusion
Confusion; decreased cerebral perfusion
Correct Answer: Dyspnea/bronchial compression

Rationale: Dyspnea occurs because the enlarged heart compresses the bronchioles, thus
diminishing the amount of oxygen entering and leaving the lungs. Additionally, blood
backs up into the lungs due to heart failure that is common to dilated cardiomyopathy.
Cyanosis, peripheral edema, and confusion may be present, but they are not the most
common clinical manifestation.
Nursing Process: Evaluation
LO: 5
15. You are admitting a 22-year-old client who is experiencing palpitations, lightheadedness, and fatigue. She has congested lungs and frothy sputum, consistent with
heart failure. Her health care provider has diagnosed her with cardiomyopathy. Which
type of cardiomyopathy is she most likely experiencing?
1.
2.
3.
4.
Arrhythmogenic right ventricular cardiomyopathy

Idiopathic hypertrophic subaortic stenosis
Dilated cardiomyopathy
Restrictive cardiomyopathy
Correct Answer: Arrhythmogenic right ventricular cardiomyopathy

Rationale: Due to her age and clinical manifestations, this client has arrhythmogenic right
ventricular cardiomyopathy. Idiopathic hypertrophic subaortic stenosis is most frequently
manifested with sudden cardiac death. She is too young for dilated cardiomyopathy and
does not have the risk factors for restrictive cardiomyopathy.
LO: 5
16. You are caring for a client with infective endocarditis who is experiencing fear and
anxiety related to changes in her health status. What nursing measures are appropriate to
help decrease the fear and anxiety?
1. Provide factual information concerning diagnosis, treatment, disfigurement,

disabilities, and prognosis.
2. Explain all procedures and allow time for mental preparation.
3. Tell the client not to worry, that everything will be fine.
4. Explain to the client that it is better not to be informed prior to procedures, as
this increases anxiety.
5. Tell the client that it is not your job to inform her about the procedure.
Correct Answer:
1. Provide factual information concerning diagnosis, treatment, disfigurement,
disabilities, and prognosis.
2. Explain all procedures and allow time for mental preparation.
Rationale: Provide factual information concerning diagnosis, treatment,
disfigurement, disabilities, and prognosis. Truthful explanations increase trust and
potentially decrease anxiety, fear, and anxiety of the unknown. Explain all procedures
and allow time for mental preparation. It is important to give the client time to process
the information to be sure it is clearly understood. Often there are more questions after
the initial explanation. Tell the client not to worry, that everything will be fine. Telling
the client not to worry is dismissive ,and fear of the unknown potentially increases
anxiety. Explain to the client that it is better not to be informed prior to procedures,
as this increases anxiety. Truthful explanations increase trust and potentially decrease
anxiety, fear, and anxiety of the unknown. Tell the client that it is not your job to
inform her about the procedure. This is an unprofessional, inappropriate response. It is
the nurses job to help decrease the clients anxiety. Accomplishing this goal may be
multifaceted. The nurse must verify the clients understanding and then notify the surgeon
that she needs to discuss the procedure so there is informed consent.
LO: 6
17. The primary goals when treating clients with hypertrophic obstructive cardiomyopathy
are:
1.
2.
3.
4.
5.
Preventing sudden cardiac death.

Preventing heart failure.
Preventing renal failure.
Preventing liver failure.
Preventing pulmonary damage.
Correct Answer:
1. Preventing sudden cardiac death.
2. Preventing heart failure.
Rationale: Preventing sudden cardiac death. Preventing heart failure and sudden
cardiac death are the primary goals of treatment for clients with hypertrophic obstructive
cardiomyopathy. Preventing heart failure. Preventing heart failure and sudden cardiac
death are the primary goals of treatment for clients with hypertrophic obstructive
cardiomyopathy. Preventing renal failure. Renal failure is not directly related to
hypertrophic obstructive cardiomyopathy. Preventing liver failure. Liver failure is not
directly related to hypertrophic obstructive cardiomyopathy. Preventing pulmonary
damage. Pulmonary damage is not directly related to hypertrophic obstructive
cardiomyopathy.
Cognitive Level: Application
LO: 6
18. When developing a teaching plan for a patient with any type of cardiomyopathy, the
nurse understands that compliance is an essential factor for this progressive disease. What
factor must the nurse determine to help ensure compliance?
1. Determine motivation factors for individual patients and create a plan that
utilizes these factors.
2. Comply with follow up health care provider visits.
3. Stop working and go on general assistance.
4. Move to an assisted living facility.
Correct Answer: Determine motivation factors for individual patients and create a plan
that utilizes these factors.
Rationale: Compliance is dependent on the clients motivating factors. Once the nurse
identifies them, the plan can be tailored to use them. Complying with health care provider
visits is only one portion of the entire plan. It may not be necessary to stop working or
move to assisted living.
LO: 6

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(Osborn) Chapter 41: Learning Outcomes (Number and Title)

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[Osborn] chapter 41

Learning Outcomes [Number and Title]

1. Cardiac tamponade is suspected in a client who has undergone a repair of a ventricular

1. The distance in mm's of Hg between the Korotkoff sounds during inspiration,

Arterial blood gases

3. Pain is associated with inflammatory heart disease. What interventions should be

Instruct client to inform nurse if pain is not relieved.

Correct Answer: Forward; backward

Discontinue activity if chest pain or shortness of breath occurs.

Correct Answer: That it is time for valve replacement.

Select all that apply.

Nurses and health care providers

A history of living in Europe

Correct Answer: A history of living in Europe

Dyspnea; bronchial compression

Correct Answer: Dyspnea/bronchial compression

Arrhythmogenic right ventricular cardiomyopathy

Correct Answer: Arrhythmogenic right ventricular cardiomyopathy

1. Provide factual information concerning diagnosis, treatment, disfigurement,

Preventing sudden cardiac death.

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