Nokea
The client is scheduled for a percutaneous balloon valvuloplasty. The client asks the nurse how long it takes for the opening to close after the procedure. How should the nurse respond?
- A. Within 1 week
- B. Within 1 month
- C. Within 6 months
- D. Within 1 year
Correct Answer: C
Rationale: The opening usually closes within 6 months of a percutaneous balloon valvuloplasty. It usually takes longer than 1 week or 1 month, but less than 1 year.
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What is the best technique to identify structural changes in the mitral valve?
- A. Chest radiography
- B. Cardiac catheterization
- C. Transthoracic echocardiogram
- D. Cardiac stress test
Correct Answer: C
Rationale: Standard transthoracic or transesophageal echocardiography is the best technique to identify structural changes in the mitral valve because the performance of the valve during the cardiac cycle can be evaluated. Chest radiography shows structures in the chest. Cardiac catheterization evaluates patency of arteries and measures pressures in cardiac chambers. Cardiac stress testing shows areas of the heart muscle that may become ischemic with exercise.
A client is scheduled for transcatheter aortic valve implantation (TAVI). Which statement from the nurse best explains this procedure to family members?
- A. A small incision in the chest wall will allow for valve repair.
- B. A catheter is used for partial replacement of the valve.
- C. A small window incision is made so a pig valve can replace the diseased valve.
- D. A complete aortic valve replacement is the best surgical treatment.
Correct Answer: B
Rationale: TAVI procedure is a minimally invasive procedure (no incision) that uses balloon valvuloplasty, stent, and partial replacement of the diseased valve using a portion of a pig valve. The TAVI is mostly used in older adults who are at high risk for the complete aortic valve replacement and helps to relieve recurring symptoms.
The client has been diagnosed with aortic regurgitation. Which nursing data is most significant in identifying the cause for this disorder?
- A. Obesity
- B. Tobacco use
- C. Fen-Phen
- D. Lack of exercise
Correct Answer: C
Rationale: The incidence of mitral and aortic regurgitation increased by as much as 36% in 1997, due to the use of fenfluramine with phentermine (Fen-Phen) for weight loss. Obesity, tobacco use, and lack of exercise have been identified as risk factors for heart disease but not a significant identified cause for aortic regurgitation.
A client who is diagnosed with aortic stenosis is scheduled for a percutaneous balloon valvuloplasty. Which statement does the nurse include when reinforcing education regarding this procedure?
- A. The balloon is placed in your heart valve and inflated.
- B. A chest incision is necessary for the scheduled procedure.
- C. You will require hospitalization for several days after the procedure.
- D. The opening from this procedure is likely to close in approximately 1 year.
Correct Answer: A
Rationale: Percutaneous balloon valvuloplasty (i.e., valvotomy) is a nonsurgical alternative for the treatment of mitral stenosis. During this procedure, a catheter with an uninflated balloon is passed through the femoral vein and threaded into the right atrium. The septum is then punctured between the right and left atria. When the catheter is in the mitral valve, it is inflated; therefore, the statement the nurse includes when reinforcing education with this client regarding this procedure is 'The balloon is placed in your heart valve and inflated.' The other statements are not appropriate for the nurse to include when reinforcing education because this procedure is nonsurgical, thus will not require a chest incision; the client is likely to be discharged the same day as the procedure, and the opening that is caused as a result of this procedure is likely to close within 6 months, not 1 year.
Before an invasive procedure, a client is prescribed antibiotics. The nurse understands the reason for this preventative action is to avoid which complication?
- A. Cardiogenic shock
- B. Infective endocarditis
- C. Congestive heart failure
- D. Rheumatic heart disease
Correct Answer: B
Rationale: Infective endocarditis can compound valvular damage but can be minimized with the preventative use of antibiotics before invasive procedures and dental work. Rheumatic heart disease is associated with the original cause of valve disease and is not prevented with prophylactic antibiotic use. Although congestive heart failure is a complication associated with valvular disease, prophylactic antibiotic therapy is not prescribed for prevention. One type of valvular disease is mitral valve regurgitation. When this occurs rapidly, the heart is less able to compensate, causing the client to develop signs of cardiogenic shock leading to pulmonary congestion. The use of antibiotics is not meant to avoid this complication.