Nokea
A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?
- A. Exposure to immunocompromised individuals
- B. Future hospital admissions
- C. Dental procedures
- D. Live vaccinations
Correct Answer: C
Rationale: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.
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A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm?
- A. Ventricular fibrillation (VF)
- B. Ventricular tachycardia (VT)
- C. Atrial fibrillation
- D. Sinus bradycardia
Correct Answer: C
Rationale: In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
The nurse is preparing a patient for cardiac surgery. During the procedure, the patients heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?
- A. Orthotopic transplant
- B. Xenograft
- C. Heterotropic transplant
- D. Homograft
Correct Answer: A
Rationale: Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipients heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipients heart, leaving a portion of the recipients atria (with the vena cava and pulmonary veins) in place. Homografts, or allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not terms used to describe heart transplantation.
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.
A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment?
- A. Heart transplantation
- B. Balloon valvuloplasty
- C. Cardiac catheterization
- D. Stent placement
Correct Answer: A
Rationale: When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Valvuloplasty, stent placement, and cardiac catheterization will not address the pathophysiology of cardiomyopathy.
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.