Nokea
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.
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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.
A client with progressive mitral valve prolapse is experiencing sympathetic nervous system symptoms in addition to prolapse symptoms. Which teaching point should be stressed by the nurse to minimize these effects?
- A. Antibiotic therapy before invasive procedures
- B. Low-dose aspirin daily
- C. Avoid caffeine.
- D. Decrease fluid and sodium intake.
Correct Answer: C
Rationale: The symptoms associated with sympathetic nervous response (anxiety, agitation, nervousness, and palpitations) are often managed with antianxiety medications and advisement to avoid caffeine and over-the-counter medications that contain stimulants. Periodic antibiotic therapy use before an invasive procedure is not associated with sympathetic nervous system symptoms. Low-dose aspirin is used to prevent thrombus formation. Decreasing fluid and sodium intake is indicated for the control of congestive failure.
The nurse provides care for an older adult client who is diagnosed with valvular heart disease. On auscultation of the client's heart sounds, the nurse notes an erratic heart rhythm. Which age-related change is the most likely cause for this finding?
- A. A stiffening of the aorta
- B. A decrease in metabolism
- C. An increase in thirst sensation
- D. A thinning of the mitral valve
Correct Answer: A
Rationale: Age-related effects, such as stiffening of the aorta, calcification, and fibrotic thickening (not thinning) of the mitral and aortic valves, contribute to development of symptoms (e.g., increased systolic blood pressure [BP], dangerous arrhythmias [erratic heart rhythms or rates that are too fast or slow] sometimes referred to as dysrhythmias) and complications (e.g., increased myocardial oxygen demand, heart failure, and alterations in cardiac output) in the older adult with valvular heart disease. A decrease in metabolism is an age-related effect for clients with valvular heart disease; however, this affects the dosage of prescribed medication and is not the cause of the client's dysrhythmia. A decrease, not increase, in thirst sensation is an age-related change that could lead to dehydration, and, thus, changes in the client's heart rhythm.
What disease process is mitral regurgitation associated with?
- A. Aortic stenosis
- B. Cellulitis
- C. Pulmonary fibrosis
- D. Rheumatic carditis
Correct Answer: D
Rationale: Mitral regurgitation is associated with rheumatic carditis and mitral valve prolapse. It is not associated with aortic stenosis, cellulitis, or pulmonary fibrosis. Aortic stenosis is a narrowing of the aortic valve, not related to the mitral valve. Cellulitis is inflammation in tissue, and pulmonary fibrosis is a scarring in the tissue of the lung.
A client is being evaluated for mitral stenosis versus mitral insufficiency. Which of the following symptoms would the nurse find in either condition?
- A. Angina
- B. Syncope
- C. Murmur
- D. High blood pressure
Correct Answer: C
Rationale: Mitral stenosis and mitral insufficiency both create regurgitation of blood back through the mitral valve which can be heard as a murmur. Angina and syncope are not common and would only be exhibited if decrease nourishment of the cardiac muscle and organs occur. Hypertension may be an underlying condition but not necessarily associated with both disorders.