Nokea
A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge?
- A. The need for long-term antibiotics
- B. The need for 7 to 10 days of bed rest
- C. Strategies for preventing atherosclerosis
- D. Strategies for infection prevention
Correct Answer: D
Rationale: Patients with a mechanical valve prosthesis (including annuloplasty rings and other prosthetic materials used in valvuloplasty) require education to prevent infective endocarditis. Despite these infections risks, antibiotics are not used long term. Activity management is important, but extended bed rest is unnecessary. Valve replacement does not create a heightened risk for atherosclerosis.
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A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following?
- A. The need for regularly scheduled testing of the patients International Normalized Ratio (INR)
- B. The need to learn to sleep in a semi-Fowlers position for the first 6 to 8 weeks to prevent emboli
- C. The need to avoid foods that contain vitamin K
- D. The need to take enteric-coated ASA on a daily basis
Correct Answer: A
Rationale: Patients who take warfarin (Coumadin) after valve replacement have individualized target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement. Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping upright is unnecessary.
The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM?
- A. Dilated ventricles with atrophy of the ventricles
- B. Dilated ventricles without hypertrophy of the ventricles
- C. Dilation and hypertrophy of all four heart chambers
- D. Dilation of the atria and hypertrophy of the ventricles
Correct Answer: B
Rationale: DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.
A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurses interview is most suggestive of this valvular disorder?
- A. I get chest pain from time to time, but it usually resolves when I rest.
- B. Sometimes when Im resting, I can feel my heart skip a beat.
- C. Whenever I do any form of exercise I get terribly short of breath.
- D. My feet and ankles have gotten terribly puffy the last few weeks.
Correct Answer: C
Rationale: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some patients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.
A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy?
- A. Dilated cardiomyopathy (DCM)
- B. Arrhythmogenic right ventricular cardiomyopathy (ARVC)
- C. Hypertrophic cardiomyopathy (HCM)
- D. Restrictive or constrictive cardiomyopathy (RCM)
Correct Answer: C
Rationale: With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.
A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse?
- A. Arrange for an alternative bed.
- B. Measure the degree of the curvature.
- C. Notify the surgeon immediately.
- D. Note the scoliosis on the intake assessment.
Correct Answer: C
Rationale: Most often used for mitral and aortic valve stenosis, balloon valvuloplasty is contraindicated for patients with left atrial or ventricular thrombus, severe aortic root dilation, significant mitral valve regurgitation, thoracolumbar scoliosis, rotation of the great vessels, and other cardiac conditions that require open heart surgery. Therefore notifying the physician would be the priority over further physical assessment. An alternative bed would be unnecessary and documentation is not a sufficient response.