Nokea
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.
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Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse?
- A. Anxiety
- B. Fatigue
- C. Shoulder pain
- D. Tachypnea
- E. Palpitations
Correct Answer: A,B,E
Rationale: Most people who have mitral valve prolapse never have symptoms. A few have symptoms of fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, and anxiety. Hyperpnea and shoulder pain are not characteristic symptoms of mitral valve prolapse.
The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following?
- A. Use of patient-controlled analgesia
- B. Long-term anticoagulant therapy
- C. Steroid therapy
- D. Use of IV diuretics
Correct Answer: B
Rationale: Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and patient-controlled analgesia may or may be not be used in the immediate postoperative period.
The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications?
- A. The nurse keeps the patient isolated to prevent nosocomial infections.
- B. The nurse encourages coughing and deep breathing.
- C. The nurse helps the patient with activities until the pain and fever subside.
- D. The nurse encourages increased fluid intake until the infection resolves.
Correct Answer: C
Rationale: To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patients condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated. Due to pain, coughing and deep breathing are not normally encouraged. An increase in fluid intake is not always necessary.
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.
The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?
- A. To eat a small meal before taking nitroglycerin
- B. To drink a glass of milk before taking nitroglycerin
- C. To engage in 15 minutes of light exercise before taking nitroglycerin
- D. To rest and relax before taking nitroglycerin
Correct Answer: D
Rationale: The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.