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123 Cards in this Set
- Front
- Back
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ENDOCARDITIS usually affects the cardiac VALVES & is most commonly caused by:
a) staph b) strep c) fungi d) virus |
a) staph
"bacterial" especially staph aureus |
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Endocarditis occurs when _______ within the heart allows the causative organism to infect previously damaged valves or other endothelial surfaces.
a) emboli b) blood flow turbulence c) fibrin d) microbes |
b) blood flow turbulence
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Until recently, the most common cause of endocarditis was rheumatic heart disease. Now, the main contibuting factors are all of the following except:
a) IV drug use b) 5-15 years of age c) increased survival rate of children w/congenital heart disease d) older people |
b) 5-15 years of age
Think Rheumatic fever for ages 5-15 |
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With endocarditis, bacterial infections & underlying heart diesease is most commonly seen in patients with:
a) Left sided endocarditis b) right sided endocarditis c) IV drug abuse d) Gram neg bacilli |
a) Left sided endocarditis
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The primary cause of right sided (tricuspid)lesions with endocarditis is:
a) gram neg bacilli b) IV abuse, especialy cocaine c) staph infections d) fungi |
b) IV abuse, especialy cocaine
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The primary lesions of endocarditis consists of fibrin, leukocytes, platelets & microbes that adhere to the valve surface or the endocardium & is referred to as:
a) emboli b) Dresslers lesions c) vegetation d) stenosis |
c) vegetation
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Infection of endocarditis may spread locally to cause damage to valves or their supporting structures resulting in valvular incompetence & eventual invasion of the:
a) pericardium b) myocardium c) lungs d) periphery |
b) myocardium
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Complications from ENDOCARDITIS is invasion of infection to the VALVES or supporting structures resulting in valvular incompetence & spread into the myocardium resulting in all of the following except:
a) CHF b) generalized myocardial dysfunction c) facial petechiae d) sepsis |
c) facial petechiae
petechiae is common sign but NOT on FACE |
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Systemic embolization occurs from from left sided heart vegetation, progressing to all of the following except:
a) brain b) kidneys c) limbs d) lungs e) limbs |
d) lungs
R-sided vegetation w/endocarditis to lungs |
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Occurs in 90% of patients w/endocarditis:
a) clubbing b) fever c) peripheral edema d) anorexia |
b) fever
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Heart valves most commonly affected by endocarditis are:
a) tricuspid b) mitral c) aortic |
b&c) aortic & mitral (left sided)
tricuspid (right-sided [to lungs]**IV drug abuse) |
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The onset of new murmer is noted in what percentage of patients w/endocarditis?
a) 10% b) 50% c) 80% d) 90% |
c) 80% (aortic & mitral most common)
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Vascular manifestations of endocarditis include all of the following except:
a) Splinter hemorrhages b) Petechiae c) Osler's nodes d) Janeway's lesions e) Roth's spots f) Hypothermia |
f) Hypothermia
HYPERthermia is the primary manifestation of endocarditis evidenced by fever! |
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Vascular manifestation of endocarditis observed primarily in conjuctivae, lips, buccal mucosa, the palate, over the ankles, the feet, & the anticubital & popliteal areas:
a) Splinter hemorrhages b) Petechiae c) Osler's nodes d) Janeway's lesions e) Roth's spots |
b) Petechiae
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Vascular manifestation of endocarditis observed as painful, tender, red or purple, pea sized lesions, which may be found of the fingertips or toes:
a) Splinter hemorrhages b) Petechiae c) Osler's nodes d) Janeway's lesions e) Roth's spots |
c) Osler's nodes
Osler peas painfully on fingertips & toes. |
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Vascular manifestation of endocarditis observed as painless, flat, small red spots on palms & soles:
a) Splinter hemorrhages b) Petechiae c) Osler's nodes d) Janeway's lesions e) Roth's spots |
d) Janeway's lesions
No pain Janeway is flat small red spots on palm souls |
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Vascular manifestation of endocarditis observed as black longtitudenal streaks in nail beds:
a) Splinter hemorrhages b) Petechiae c) Osler's nodes d) Janeway's lesions e) Roth's spots |
a) Splinter hemorrhages
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Vascular manifestation of endocarditis observed with Funduscopic examination which reveals retinal lesions:
a) Splinter hemorrhages b) Petechiae c) Osler's nodes d) Janeway's lesions e) Roth's spots |
e) Roth's spots
Cotton Roth Spots |
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Occurs in 80% of of patient's with aortic valve endocarditis & aproximately 50% of those w/mitral valve endocarditis:
a) splinter hemorrhages b) CHF c) sepsis d) rheumatic fever |
b) CHF
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Clinical manifestations of endocarditis which may result in sharp, LUQ pain abd, tenderness & abd rigidity are:
a) S/T embolization to the kidney b) S/T embolization to pancreas c) S/T embolization to spleen d) S/T embolization to perimetrium |
c) S/T embolization to spleen
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Clinical manifestations S/T embolization in various body organs may be present with endocarditis. Name 5 of these body organs
1- S_ _ _ _ _ 2- K_ _ _ _ _ _ 3- P_ _ _ _ _ _ _ _ _ B_ _ _ _ V_ _ _ _ _ _ 4- B_ _ _ _ 5- L_ _ _ _ |
1- spleen
2- kidneys 3- peripheral blood vesels 4- brain 5- lungs |
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In assessing for endocarditis, inquirey should be made regarding any recent dental work within:
a) present to last 6 weeks b) within past 3-6 months c) within past 6-12 months d) within last 6 years |
b) within past 3-6 months
also includes assessing for recent HX of urologic, sugical, or gynecologica procedures including normal or abnormal obstetric delivery |
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The primary diagnostic tool for the evaluation of endocarditis:
a) transesophageal echocardiogram b) transthoracic echocardiogram c) electrocardiogram d) echocardiography d) blood cultures e) chest X-ray f) cardiac cath |
d) blood cultures
all other tests listed are also useful for diagnostics of endocarditis: **Transesophageal or transthoracic echocardiogram= detects vegetations & abscesses on valves **Electrocardiogram=detects AV block **Echocardiography=when blood cultures are neg or for Pt who is a surgical candidate **Chest X-Ray=detect enlarged heart **Cardiac cath=evaluates valve fxn when surgery is being considered |
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A mild leukocytosis occurs in acute endocarditis (uncommon in sub-acute) with an avg WBC ranging from:
a) 100,000 to 11,000 b) 10,000 to 100,000 c) 100,000 to 110,000 d) 10,000 to 11,000 |
d) 10,000 to 11,000
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In almost all cases of endocarditis, erythrocyte sedimentation rates are greater than:
a) 10,000uL b) 100,000uL c) 30mm d) 130mm |
c) 30mm
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Marfan syndrom is a predisposing condition for the development of infective endocarditis?
true/false |
true
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A type of endocarditis that is more common in those with a pre-existing heart disease:
a) acute b)sub-acute |
b)sub-acute
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Petechiae, splinter hemorrhages, Osler's nodes, Janeway's lesions, & Roth's spots are all:
(choose the statement that best describes these categorically) a) S&S of endocarditis b) S&S of circulatory hemorrhages c) S&S of valvular dysfunction d) manifestations of embolic complications |
d) manifestations of embolic complications
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With endocarditis, elevated serum creatinine is indicative of:
a) damage of the musculature b) damage to the myocardium c) pulmonary embolisms d) renal involvement |
d) renal involvement
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The principle risk factors for infective endocarditis are prior endocarditis, non cardiac diseases. auired valvular disease and 3 other identified conditions. Name them.
1- _ _ _ _ _ _ _ lesions 2- prothetic _ _ _ _ _ _ 3- m_ _ _ _ _ valve p_ _ _ _ _ _ _ |
1- cardiac lesions
2- prothetic valves 3- mitral valve prolapse |
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Which conditions are considered to be high risk conditions that require antibiotic phrophyaxis to prevent endocarditis:
a) history of rheumatic fever w/out heart murmur b) prosthetic heart valve c) organic heart murmur d) mitral valve prolapse w/out valvular regurgitation e) surgically constructed systemic pulmonary shunts f) mitral valve prolapse w/valvular regurgitation g) history of endocarditis h) functional, physiologic, or innocent heart murmur |
b) prosthetic heart valve
e) surgically constructed systemic pulmonary shunts g) history of endocarditis |
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Which conditions are considered to be moderate risk conditions that require antibiotic phrophyaxis to prevent endocarditis:
a) history of rheumatic fever w/out heart murmur b) prosthetic heart valve c) organic heart murmur d) mitral valve prolapse w/out valvular regurgitation e) surgically constructed systemic pulmonary shunts f) mitral valve prolapse w/valvular regurgitation g) history of endocarditis h) functional, physiologic, or innocent heart murmur |
c) organic heart murmur
f) mitral valve prolapse w/valvular regurgitation |
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Which conditions are considered to be low risk conditions that will not require antibiotic phrophyaxis for the prevention of endocarditis:
a) history of rheumatic fever w/out heart murmur b) prosthetic heart valve c) organic heart murmur d) mitral valve prolapse w/out valvular regurgitation e) surgically constructed systemic pulmonary shunts f) mitral valve prolapse w/valvular regurgitation g) history of endocarditis h) functional, physiologic, or innocent heart murmur |
a) history of rheumatic fever w/out heart murmur
d) mitral valve prolapse w/out valvular regurgitation h) functional, physiologic, or innocent heart murmur |
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Antibiotics used to TX endocarditis is an extended course of therapy for which the causastive agents must be accurately identified for successful TX. The most common antibiotics used are:
a) Penicillin b) Gentamycin |
BOTH
Gentamycin is very harmful to kidney's |
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For the patient with prosthetic valve endocarditis, extended antiobiotic therapy may be required for:
a) 6-8 days b) 6-8 weeks c) 6-8 months d) 6-8 years |
b) 6-8 weeks
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Surgery for endocarditis may be indicated for replacement of damaged valves, removal of large vegetations at risk for embolization, or removal of a valve that is a continuing source of infection. Removal of a valve is indicated when it is a continuing source of infection that does not respond to antibiotic therapy in:
a) 7-10 days b) 7-10 days or is identified as fungal c) 6-8 weeks d) 6-8 weeks or is identified as fungal |
b) 7-10 days or is identified as fungal
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Your patient is diagnosed with endocarditis and his fever has persisted for several days after antibiotic therapy was started. You anticipate:
a) valvular replacement is imminent b) the presence of aortic root or myocardial abscesses c) the cause is innappropriate antibiotic therapy d) administering aspirin, acetamenophen, fluids, & rest |
d) administering aspirin, acetamenophen, fluids, & rest
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NDX for the patient with endocarditis (fill in the blanks):
Hyperthermia RT infection of _____ _____ AMB temp elevation, diaphoresis, chills, HA, malaise, tachy_ _ _ _ _ _ & tachy_ _ _ _. |
cardiac tissue
tachycardia tachypnea |
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NDX for the patient with endocarditis (fill in the blanks):
_____ cardiac output RT valvular insufficiency & ____ ____ AMB heart murmur, S3, tachycardia, diminished peripulses, adventicious breath sounds, ____ urine output, & restlessness. |
Decreased
fluid overload decreased |
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NDX for the patient with endocarditis (fill in the blanks):
Activity intolerance RT generalized ____ & alteration in 02 transport ST valvular dysfunction AMB fatigue, malaise, weakness, dyspnea,increased or decreased ____ ____ & BP changes. |
weakness
respiratory rate |
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Primary nursing intervention that helps reduce the incidence & recurrance of endocarditis in the patient who is at risk for, or who has had infective endocarditis:
a) avoiding excessive fatigue & plan rest before & after activity b) good oral hygiene c) teaching d) avoidance of those with URI's & report cold, flu, & cough synptoms e) phrophylactic antibiotic TX before any invasive procedure |
c) teaching
and ... teach everything on this list! |
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Primary nursing assessments/interventions for patients with infective endocarditis:
a) BP, urinary output, peripheral pulses b) pain, respiratory rate, urinary output c) rest, urinary output, fever d) fever, rest, lab data monitoring |
d) fever, rest, lab data monitoring
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The nurse anticipates the patient w/endocarditis will require TX w/antibioticas for 4-6 weeks(txtbook p.892). The nurse also expects patient will require in-hospital TX & then may be a candidate for outpatient parenteral antibiotic TX. Assessing patient's temperature, providing adequate rest, & monitoring lab studies for effectivness of the long-term & high dose antibiotic TX is important in addition to:
a) monitoring IV lines for patency b) undesireable reactions to drugs c) elastic compression gradient stockings d) perform ROM exercises e) TCDB q2h f) reduce fears & anxieties |
ALL OF THESE
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Patients with endocarditis are at risk for what life threatening complications?
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cerebral emboli
pulmonary edema |
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The nurse will teach the patient returning to home to notify the health care provider immediately of what symptoms?
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fever, fatgue, malaise, chills
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What is so important before administering the initial dose of antibiotics to the patient with endocarditis?
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obtain blood cultures as ordered
**follow PEAK & TROUGH drug levels as indicated !!! |
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A patient w/HX of IV cocaine use has acute infective endocarditis. The nurse closely assess the Pt for S&S of:
a) pulmonary emboli b) increased cardiac output c) streptococcal bacteremia d) mitral valve regurgitation |
a) pulmonary emboli
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In a normal state, the pericardial space contains _______ of serous fluid:
a) trace b) 30 mL c) 50 mL d) 100 mL |
c) 50 mL
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Acute pericarditis is usually:
a) bacterial b) viral c) fungal d) lymphatic |
b) viral
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Pericarditis is a condition caused by inflammation of the:
a) myocardium b) pericardial sac c) right atrium d) left atrium |
b) pericardial sac
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Infectious causes of pericarditis are all of the following except:
a) viruses b) bacteria c) fungi d) syphillis e) parisites |
All of these are causes of pericarditis with VIRUS being the most common cause for ACUTE pericarditis & most specifically COXSACKI B
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Acute pericarditis is most often idiopathic with a variety of suspected viral causes with the coxackievirus B most commonly identified. However, other causes for acute pericarditis are all of the following except:
a) uremia b) bacterila infection c) acute MI d) TB e) neoplasm f) trauma |
all of these are also known causes for acute pericarditis in addition to surgery, myxedema, autoimmune disorders, rheumatic fever, connective tissue diseaes, prescription & nonprescription drugs, & post cardiac surgery
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Pericarditis is caused by:
a) vegetation of the pericardium b) pulmonary edema c) an inflammatory response d) less than 50 mL of serous fluid in pericardial sac |
c) an inflammatory response
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The characteristic pathological finding of pericarditis is an inflammatory response in which there is an influx of _____, increased pericardial vascularity & eventual fibrin deposition on the visceral pericardium:
a) platelets b) WBC's c) neutrophils d) lymphocytes |
c) neutrophils
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What are the 3 main clinical manifestations found in acute pericarditis?
1- c_ _ _ _ pain 2- dy_ _ _ _ _ 3- f_ _ _ _ _ _ _ rub |
1- chest pain
2- dypnea 3- pericardial friction rub |
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Chest pain from pericarditis is described as intense pleuritic chest pain that is generally sharpest over the left precordium or retrosternal. Pain may radiate to the trapezius ridge & neck, mimicking angina, or the epigastrum or ABD mimicking ABD conditions. The pain is aggravated by all of the following except:
a) lying supine b) deep breathing c) coughing d) swallowing e) sitting up & leaning forward |
e) sitting up & leaning forward
THIS RELIEVES PAIN |
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Patients with pericarditis tend to breath:
a) with delayed & deep respirations b) rapid & deep respirations c) deep respirations & couophing w/expirations d) rapid & shallow breaths |
d) rapid & shallow breaths
....to avoid chest pain |
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A hallmark finding in patients with pericarditis is:
a) Dresslers syndrome b) rapid, bounding pulse c) hypovolemia d) pericardial friction rub |
d) pericardial friction rub
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A pericardial friction rub is a scratchy, grating, high pitched sound that is believed to arise from friction between the roughened pericardial & epicardial surfaces & best heard w/stethescope diaphragm firmly placed at the:
a) upper left sternal border of the chest b) upper right sternal border of the chest c) lower left sternal border of the chest d) lower right sternal border of the chest |
c) lower left sternal border of the chest
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Identify from the following the 3 major complications that result from pericarditis:
a) myocardial infiltration b) pulmonary edema c) pericardial effusion d) cardiac tamponade e) constrictive pericarditis (chronic) |
c) pericardial effusion
and ... d) cardiac tamponade and ... e) constrictive pericarditis (chronic) |
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A rapid or slow accumulation of excess fluid in the pericardium is known as:
a) Dresslers syndrome b) pericardial effusion c) cardiac tamponade d) chronic pericarditis |
b) pericardial effusion
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Pericardial effusion can occur raidly from chest trauma or slowly from TB pericarditis & large effusions may compress adjoining structures. Pulmonary tissue compression is suspected with all of the following except:
a) cough b) dyspnea c) tachypnea d) hiccups |
d) hiccups
Hiccups is charachteristic with compression of the phrenic nerve |
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Name the symptom associated with the compression on adjoining sites (listed below) caused by peroicardial effusion:
1- compression on pulmonary tissue = 2- compression of phrenic nerve = 3- compression on laryngeal nerve = |
1-pulmonary tissue = cough, dyspnea, & tachypnea
2- phrenic nerve = hiccups 3- laryngeal nerve = hoarsness |
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Heart sounds in patients with acute pericarditis are generally distant & muffled, & blood pressure continues to decrease.
true/false |
false
BP is usually maintained by compensatory mechanisms |
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Develops as pericardial effusion increases in size:
a) Dresslers syndrome b) chronic pericarditis c) cardiac tamponade d0 valvular vegetation |
c) cardiac tamponade
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The patient with cardiac tamponade associated with acute pericarditis is often all of the following except:
a) sleepy & lethargic b) confused & agitated c) tachycardia & tachypnea d) JVD & pulsus paradoxus |
a) sleepy & lethargic
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Key diagnostic clues which are developed over a period of hours to days or weeks in patients with pericarditis are obtained with:
a) blood lab studies b) serum pH & alkalinity c) electrocardiogram d) echocardiogram |
c) electrocardiogram
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With cardiac tamponade, in association with pericarditis, the neck veins are usually markedly distended because of jugular venous pressure elevation & a significant pulsus paradoxus is present. Pulsus paradoxus is an inspiratory drop in systolic BP greater than:
a) 10 mm Hg b) 12 mm Hg c) 15 mm Hg d) 20 mm Hg |
a) 10 mm Hg
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Labooratory studies for patients w/pericarditis is dirested towards identifying & TX of the underlying problem. BUN & serum creatinine levels that would indicate uremic pericarditis when levels are:
a) elevated b) decreased |
a) elevated
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Management of acute pericarditis is directed towards what 2 things?
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1- identification of underlying cause
2- Tx of underlying problem |
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Primary TX for pericarditis (bacterial) is:
a) diuretics b) prednisone c) antibiotics d) corticosteroids |
c) antibiotics
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Assessment of patients with acute pericarditis is observing for the presence of chest pain, tachycardia, muffled heart sounds, & cool mottles skin. Can you name at least 3 other S&S of acute pericarditis?
1- J_ _ 2- Narrowed ____ pressure 3- h____tension 4- weak ______ pulses 5- peripheral _____ 6- low ____ output 7- _____ pulse |
1-JVD
2- narrowed pulse pressure 3- HYPOtension 4- weak peripheral pulses 5- peripheral cyanosis 6- low urine output 7- paradoxical pulse |
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The pain & inflammation of acute pericarditis are usually TX with:
a) morphine b) NSAIDS c) beer d) candy |
b) NSAIDS
corticosteriods are not first line TX |
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Pericardiocentesis is usually performed:
a) pericardial effusion has occured b) when acute cardiac tamponade has elevated the patients diastolic BP by 30 mm Hg or more from baseline c) when acute cardiac tamponade has reduced the patients diastolic BP by 30 mm Hg or more from baseline d) when acute cardiac tamponade has reduced the patients systolic BP by 30 mm Hg or more from baseline |
d) when acute cardiac tamponade has reduced the patients systolic BP by 30 mm Hg or more from baseline
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A pericardiocentesis involves the introduction of an 8-inch ___-___ guage needle into the pericardial space, insertion of a catheter, & removal of fluid.
a) 8-10 guage needle b) 10-12 guage needle c) 12-14 guage needle d) 16-18 guage needle |
d) 16-18 guage needle
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The primary nursing consideration for a patient with acute pericarditis is:
a) managing pain b) infection control c) rest d) teaching |
a) managing pain (& anxiety)
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Managing pain & anxiety in patients with pericarditis is the primary nursing consideration & assessing the amount, quality, & location of pain is important particualarly in distinguishing the pain of pericarditis from:
a) constrictive pericarditis b) cardiac tamponade c) MI d) myocarditis |
c) MI
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When assessing a patients pain it is important to observe for ischemic chest pain (assoc with MI) which is generally:
a) located in the precordium, relieved by leaning forward b) located in the left trapezius ridge & relieved when supine c) relieved by supine position d) retrosternal in left shoulder & arm, burning, & unaffected by posture |
d) retrosternal in left shoulder & arm, burning, & unaffected by posture
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Pain relief measures for patients with pericarditis include:
a) left recumbant b) right recumbant c) HOB 90 degrees d) HOB 45 degrees |
d) HOB 45 degrees
Pain is reduced by sitting upright & leaning forward. (moves heart away fron the diaphragmatic side of the lung pleura) |
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Because of the potential for upper GI bleeding with the use of high doses of antiinflammatory medications used in managing pain, for those with pericarditis, specific nursing interventions include:
a) administer with juice b) administer 30min-1hr after meals c) administer with food or milk d) administer 30 min before meals |
c) administer with food or milk
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Results from scarring with consequent loss of elasticity of the pericardial sac:
a) pericardial effusion b) cardiac tamponade c) acute pericarditis d) chronic constrictive pericarditis |
d) chronic constrictive pericarditis
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Occurs over an extended period of time & mimicks CHF & cor pulmonale:
a) pericardial effusion b) cardiac tamponade c) acute pericarditis d) chronic constrictive pericarditis |
d) chronic constrictive pericarditis
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The most prominant finding of chronic constrictive pericarditis is:
a) pulsus paradoxus b) elevated jugular venous pressure c) dyspnea on exertion d) fatigue & weight loss |
b) elevated jugular venous pressure
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Ausculatory findings in patients w/chronic constrictive pericarditis are:
a) muffled heart sounds b) pericardial knock c) S3 & S4 heart sounds d) rhonchi |
b) pericardial knock
(loud & early diastolic sound often heard along the left sternal border |
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With chronic constrictive pericarditis, unless the Pt is free of symptoms or the condition is inoperable, the TX of choice is:
a) percardiocentesis b) pericardiectomy c) life-long diuretic therapy d) life-long antibiotic therapy |
b) pericardiectomy
usually involves complete resection of pericardium through median sternotomy w/cardiopulmonary bipass. Recovery may be immediate or may take weeks & prognosis is good if performed before severe clinical disability. |
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Th enurse suspects cardiac tamponade in a Pt with acute pericarditis based on the finding of:
a) chest pain b) pulsus paradoxus c) mitral valve murmur d) pericardial friction rub |
b) pulsus paradoxus
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A patient w/acute pericarditis has markedly distended jugular veins, decreased blood pressure, tachycardia, tachypnea, & muffled heart sounds. The nurse recognizes these symptoms occur when:
a) the pericardial space is obliterated w/scar tissue & thickened pericardium b) excess pericardial fluid comprresses the heart & prevents adequate diastolic filling c) the parietal & visceral pericardial membranes adhere to each other preventing normal myocardial contraction d) fibrin accumulates on the visceral pericardium infiltrates into the myocardium creating generalized myocardial dysfunction |
b) excess pericardial fluid comprresses the heart & prevents adequate diastolic filling
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To measure a pulsus paradoxus, the nurse determines:
a) the difference between the systolic pressure at inspiration & the systolic pressure at expiration b) the difference between the systolic pressure at inspiration & the diastolic pressure at expiration c) the difference between the diastolic pressure at inspiration & the diastolic pressure at expiration d) the difference between the systolic pressure at expiration & the systolic pressure heard through the respiratory cycle |
d) the difference between the systolic pressure at expiration & the systolic pressure heard through the respiratory cycle
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A pulsus paradoxus of >10 mm Hg occurs with:
a) acute pericarditis b) chronic constrictive pericarditis c) pericardial effusion d) cardiac tamponade |
d) cardiac tamponade
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A pericardiocentesis is indicated for the patient with pericarditis when there is a drop in patients blood pressure from baseline of:
a) 10 mm Hg or less b) 30 mm Hg or less c) 10 mm Hg or more d) 30 mm Hg or more |
d) 30 mm Hg or more
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A patient w/acute pericarditis has a NDX of pain RT pericardial inflammation. An appropriate nursing intervention is:
a) administering narcotics as prescribed around the clock b) promoting progressive relaxation exercises w/deep & slow breathing c) position Pt on R-side w/HOB 15 degrees d) positioning Pt in Fowler's w/ padded overbed table for the patient to lean on |
d) positioning Pt in Fowler's w/ padded overbed table for the patient to lean on
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Inflammation of the heart muscle is:
a) myocarditis b) acute pericarditis c) chronic constrictive pericarditis d) rheumatic fever |
a) myocarditisMyocarditis is inflammation of the heart muscle usually occurring from an infectious process but may also occur as an i
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Myocarditis is inflammation of the heart muscle usually occurring from an infectious process but may also occur as an immunologic response, as an effect of all the following except:
a) radiation b) toxins c) drugs d) pregnancy |
d) pregnancy
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In the U.S., myocarditis is usually caused by:
a) coxsackie virus B b) coxsackie virus A c) staphylococci d) streptococci |
a) coxsackie virus B
myocarditis ---usually VIRAL |
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Approximately 10% of these patients will develop myocarditis:
a) rheumatic fever b) mumps c) cardiac tamponade d) HIV |
d) HIV
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If myocarditis is bacterial, it may be associated with:
a) Strep b) rheumatic fever c) diptheria d) staph aureus |
c) diptheria
AND ... d) staph aureus |
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In Central & South America, myocarditis is commonly coused by:
a) fungal infxn b) rheumatic fever c) diptheria d) parasitic infxn |
d) parasitic infxn
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Myocarditis is frequently associated with:
a) HIV b) IV drug abuse c) cocaine d) acute pericarditis |
d) acute pericarditis
(especially when caused by coxsackie B strains or echoviruses) |
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The pathophysiologic mechanisms of myocarditis is not well understood because there is usually a period of several weeks after the initial infection before manifestations develop.
true/false |
true
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The clinical features of myocarditis are all of the following except:
a) severe heart involvement b) sudden death c) pharyngitis d) lymphadenopathy |
All of these are signs!
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Clinical characteristics of myocarditis range from a benign course w/out any overt manifestations to severe heart involvement or sudden death. Early signs include, fever & fatigue, malaise & myalgia, pharyngitis & dyspnea, lymphadenopathy & N&V. After viral infection early manifestations appear in:
a) 1-3 days b) 3-7 days c) 7-10 days d) 7-10 weeks |
c) 7-10 days
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Early cardiac manifestations of myocarditis appear 7-10 days after viral infxn & include pericardial chest pain with an associated:
a) crampin in left arm b) increased thirst c) abdominal cramping d) friction rub |
d) friction rub
(because.. pericarditis often accompanies myocarditis) |
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Name 4 cardiac signs of myocarditis:
1- S_ 2- C_ _ _ _ _ _ _ 3- j_ _ _ _ _ _ venous distension 4- p_ _ _ _ _ _ _ _ _ edema |
1- S3
2- crackles 3- jugular venous distention 4- peripheral edema |
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Cardiac signs of myocarditis may progress to CHF, pericardial effusion, ____ & possibly ____ pain.
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syncope
ischemic |
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Confirmation of myocarditis:
a) is achieved by lab studies revealing any elevation of Troponin b) has yet to be esablished & has been a source of controvery for more than 20 years. c) is possible through endomyocardial biopsy d) is with elevated creatine kinase & troponin levels. |
c) is possible through endomyocardial biopsy
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TX of myocarditis focuses on:
a) the antiviral therapy b) inhibiting the elevation of cardiac markers Troponin & creatine kinase c) resolving the inflammatory process to prevent further damage to the myocardium d) resolving the infectious process to prevent further damage to the myocardium |
c) resolving the inflammatory process to prevent further damage to the myocardium
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Patients with myocarditis are particularily sensitive to:
a) low molecular weight heparin b) corticosteroids c) NSAIDS d) digitalis |
d) digitalis
Digitalis is used with caution in Pt's w/myocarditis |
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Patient's with myocarditis can expect limitations of activity for up to:
a) 10-21 days b) 3 weeks to 3 months c) 6 to 12 months d) 1 to 3 years |
c) 6 to 12 months
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An ongoing NDX in the care of a Pt w/myocarditis is all of the following except:
a) activity intolerance b) decreased cardiac output c) fatigue d) deficient fluid volume e) anxiety |
d) deficient fluid volume
EXCESS fluid volume is most likely! |
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The majority of Pt's w/myocarditis:
a) die within 2 years b) progress to chronic dilated cardiomyopathy c) have HIV d) recover spontaneously |
d) recover spontaneously
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When obtaining a nursing history for a Pt w/myocarditis, the nurse specifically questions the patient about:
a) prior use of digoxin b) recent S&S of a viral illness such as fever & malaise c) recent strep infection d) hx of coronary disease with or without MI |
b) recent S&S of a viral illness such as fever & malaise
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A systemic inflammatory disease caused by an abnormal immune response to pharyngeal infection by group A beta-hemolytic streptococci:
a) rheumatic fever b) endocarditis c) myocarditis d) pericarditis |
a) rheumatic fever
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Rheumatic Fever is a systemic inflammatory disease caused by an abnormal immune response to pharyngeal infection by group A beta-hemolytic streptococci. This disease affects people of any age, but peak occurrence is:
a) 40 + years b) 0 - 20 years c) 65 + years d) 5 - 15 years |
d) 5 - 15 years
RARE after 40 years |
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Rheumatic fever is generally:
a) self limiting b) acute c) recurrent d) chronic |
Generally this is a self-limited disease, but it may become recurrent or chronic
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The heart is commonly involved in this acute inflammatory response, but only about 10% of people with rheumatic fever develop:
a) pericarditis b) myocarditis c) endocarditis d) rheumatic haert disease |
d) rheumatic haert disease
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When rheumatic heart disease does develop, it frequently damages the heart valves and is a major cause of:
a) tricuspid valve disorders b) mitral & aortic valve disorders c) pericarditis d) pulmonary embolisms |
b) mitral & aortic valve disorders
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Rheumatic fever is thought to result from an abnormal immune response to proteins on group A beta hemolytic:
a) strep bacteria b) staph bacteria |
a) strep bacteria
STREP THROAT |
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Rheumatic fever is thought to result from an abnormal immune response to proteins on group A beta hemolytic strep bacteria(Often follows a “strep throat”) Inflammatory lesions develop:
a) in mitral & aortic valves b) pericardial space c) myocardium d) connective tissues of the heart, joints, & skin |
d) connective tissues of the heart, joints, & skin
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This condition developes in about 50% of people with rheumatic fever:
a) cor pulmonale b) cardiac tamponade c) pericardial effusion d) inflammation of the heart (carditis) |
d) inflammation of the heart (carditis)
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With rheumatic fever, localized areas of tissue necrosis develop in cardiac tissues called:
a) embolisms b) vegetations c) sporanocytes d) Aschoff bodies |
d) Aschoff bodies
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With rheumatic fever, pericardial and myocardial inflammation tends to be:
a) mild and self-limiting b) moderate & self limiting c) severe but self limiting |
a) mild and self-limiting
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In rheumatic fever, Aschoff bodies (localized areas of tissue necrosis) develop in cardiac tissues. Pericardial & myocardial inflammation tends to be mild & self-limiting, however, _____ ____ causes swelling & erythema of valve structures:
a) myocardial necrosis b) endocardial inflammation c) valvular vegetations d) pericardial effusion |
Endocardial inflammation
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In rheumatic fever, Aschoff bodies (localized areas of tissue necrosis) develop in cardiac tissues. Pericardial & myocardial inflammation tends to be mild & self-limiting, however, endocardial inflammation causes swelling & erythema of valve structures & small ___ ___ on valve leaflets:
a) vegetative lesions b) abscesses c) fibrous scarring |
a) vegetative lesions
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