Nokea
An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patients echocardiogram?
- A. Blood to flow back from the aorta to the left ventricle
- B. Obstruction of blood flow from the left ventricle
- C. Blood to flow back from the left atrium to the left ventricle
- D. Obstruction of blood from the left atrium to left ventricle
Correct Answer: A
Rationale: Aortic regurgitation occurs when the aortic valve does not completely close, and blood flows back to the left ventricle from the aorta during diastole. Aortic regurgitation does not cause obstruction of blood flow from the left ventricle, blood to flow back from the left atrium to the left ventricle, or obstruction of blood from the left atrium to left ventricle.
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A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs?
- A. Enoxaparin (Lovenox)
- B. Metoprolol (Lopressor)
- C. Azathioprine (Imuran)
- D. Amoxicillin (Amoxil)
Correct Answer: D
Rationale: Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.
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.
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 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.
A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurses assessment findings is most consistent with myocarditis?
- A. Sudden changes in level of consciousness (LOC)
- B. Peripheral edema and pulmonary edema
- C. Pleuritic chest pain
- D. Flulike symptoms
Correct Answer: D
Rationale: The most common symptoms of myocarditis are flulike. Chest pain, edema, and changes in LOC are not characteristic of myocarditis.