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A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty?
- A. For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.
- B. Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well.
- C. Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay.
- D. Its prudent to get a second opinion before deciding to have valvuloplasty.
Correct Answer: A
Rationale: Some valvuloplasty procedures do not require general anesthesia or cardiopulmonary bypass and can be performed in a cardiac catheterization laboratory or hybrid room. Open heart surgery is not required and the procedure does not carry exceptional risks that would designate it as being dangerous. Normally there is no need for the nurse to advocate for a second opinion.
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A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physicians choice of antibiotics would be primarily based on what diagnostic test?
- A. Echocardiography
- B. Blood cultures
- C. Cardiac aspiration
- D. Complete blood count
Correct Answer: B
Rationale: To help determine the causative organisms and the most effective antibiotic treatment for the patient, blood cultures are taken. A CBC can help establish the degree and stage of infection, but not the causative microorganism. Echocardiography cannot indicate the microorganisms causing the infection. Cardiac aspiration is not a diagnostic test.
A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient?
- A. Patients generally stay in the hospital for 6 to 8 days.
- B. Patients are kept in the hospital until they are independent with all aspects of their care.
- C. Patients need to stay in the hospital until they regain normal heart function for their age.
- D. Patients usually remain at the hospital for 24 to 48 hours.
Correct Answer: D
Rationale: After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.
A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurses admission interview, the patient states that she takes over-the-counter water pills on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics?
- A. Encourage the patient to drink at least 2 liters of fluid daily.
- B. Increase the patients oral sodium intake.
- C. Inform the care provider because diuretics are contraindicated.
- D. Ensure that the patients fluid balance is monitored vigilantly.
Correct Answer: C
Rationale: Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware. Adjusting the patients sodium or fluid intake or fluid monitoring does not address this important contraindication.
A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patients symptoms, the nurse should teach the patient to do which of the following?
- A. Eat a high-protein, low-carbohydrate diet.
- B. Avoid activities that cause an increased heart rate.
- C. Avoid large crowds and public events.
- D. Perform deep breathing and coughing exercises.
Correct Answer: B
Rationale: Patients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.
A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this?
- A. To prevent bacterial endocarditis
- B. To prevent hospital-acquired pneumonia
- C. To minimize the need for antibiotic use during the procedure
- D. To decrease the need for surgical asepsis
Correct Answer: A
Rationale: Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to decrease the need for surgical asepsis.