Nokea
A client reports a family history of aortic stenosis. Which assessment finding would the nurse identify as a likely contributing factor?
- A. High blood pressure
- B. Missing aortic cusp
- C. Unidirectional blood flow
- D. Chest pain
Correct Answer: B
Rationale: In young adults, aortic stenosis usually is a consequence of a congenital defect in which the valve has two instead of three cusps. High blood pressure and chest pain are symptoms that can be exhibited in aortic stenosis. Unidirectional blood flow is the normal flow of blood through the heart.
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The nurse is caring for a client with mitral stenosis. Which assessment finding would cause the greatest concern in providing nursing care to this client?
- A. Decreased pulmonary pressure
- B. Increased cardiac output
- C. Decreased right ventricular pressure
- D. Increased left atrial pressure
Correct Answer: A
Rationale: A damaged mitral valve leads to incomplete emptying of the left atrium and accumulation of blood resulting in increased pressure. As the backup of blood continues, pressure is increased into the lungs and right ventricle and cardiac output decreases.
What must the nurse assess for to determine adequate care for a client with aortic stenosis?
- A. Increased systolic pressure
- B. Calcification of aortic valve
- C. Angina
- D. Systolic murmur
Correct Answer: C
Rationale: Angina indicates insufficient nourishment of the myocardium, which can increase the risk for mortality. The systolic blood pressure increases to force blood through the narrowed opening, and systolic murmurs can be identified in some clients, but are not the most important factors. Calcification of the aortic valve is a cause for the disorder.
The nurse is caring for a client who just received a percutaneous balloon valvuloplasty for the treatment of mitral stenosis. For which finding should the nurse assess?
- A. Rejection of porcine graft
- B. Mitral regurgitation
- C. Infection at incision site
- D. Blood shunting from right to left atrium
Correct Answer: B
Rationale: The balloon valvuloplasty stretches the valve and can impair the papillary muscles, resulting in regurgitation of blood back through the mitral valve. A percutaneous balloon valvuloplasty does not have an incision and does not use a porcine graft. The septum is perforated and can allow shunting of blood but the shunting, if occurs, will move from left to right.
A client who is diagnosed with aortic stenosis is scheduled for a percutaneous balloon valvuloplasty. Which statement does the nurse include when reinforcing education regarding this procedure?
- A. The balloon is placed in your heart valve and inflated.
- B. A chest incision is necessary for the scheduled procedure.
- C. You will require hospitalization for several days after the procedure.
- D. The opening from this procedure is likely to close in approximately 1 year.
Correct Answer: A
Rationale: Percutaneous balloon valvuloplasty (i.e., valvotomy) is a nonsurgical alternative for the treatment of mitral stenosis. During this procedure, a catheter with an uninflated balloon is passed through the femoral vein and threaded into the right atrium. The septum is then punctured between the right and left atria. When the catheter is in the mitral valve, it is inflated; therefore, the statement the nurse includes when reinforcing education with this client regarding this procedure is 'The balloon is placed in your heart valve and inflated.' The other statements are not appropriate for the nurse to include when reinforcing education because this procedure is nonsurgical, thus will not require a chest incision; the client is likely to be discharged the same day as the procedure, and the opening that is caused as a result of this procedure is likely to close within 6 months, not 1 year.
The nurse is interviewing a client who is being admitted for possible mitral regurgitation. Which historical fact is of greatest value to the nurse?
- A. Congenital neural tube defect
- B. Rheumatic fever
- C. One-pack-a-day smoker for 20 years
- D. Pacemaker inserted 2 years ago
Correct Answer: B
Rationale: Rheumatic fever and subsequent heart disease is the prominent cause of valvular insufficiency. Congenital neural tube defect is associated with spina bifida not mitral regurgitation. Smoking and insertion of pacemaker are significant to heart disorders but not of greatest value as rheumatic fever.