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The nurse is caring for a client who is having a mitral valve replacement with a mechanical valve. What instructions should the nurse be sure the client understands prior to being discharged?
- A. The valve should last for 10 to 15 years.
- B. The client will require anticoagulation.
- C. There is a low potential for thrombi formations so anticoagulation is not necessary.
- D. The valve is prone to calcification.
Correct Answer: B
Rationale: A mechanical valve should last at least 20 years. The disadvantages are the risk for thrombi and emboli, so anticoagulation is necessary. There is a risk of bleeding, and there can be a sudden malfunction in the valve. An allograft will last 10 to 15 years. A bioprosthetic valve does not require anticoagulation but is prone to deterioration and calcification.
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The nurse is obtaining vital signs for a client in the clinic who has had a cardiac transplant. The nurse obtains an apical heart rate of 110 beats/minute. What is a priority action by the nurse?
- A. Obtain an electrocardiogram.
- B. Notify the physician.
- C. No action is required because the transplanted heart beats faster than the natural heart.
- D. Administer a calcium channel blocker to decrease the heart rate.
Correct Answer: C
Rationale: The transplanted heart beats faster than the client's natural heart, averaging about 100 to 110 beats/minute, because nerves that affect heart rate have been severed. The new heart also takes longer to increase the heart rate in response to exercise. If the client is asymptomatic, there is no reason to obtain an ECG or notify the physician. The nurse would not administer the calcium channel blocker without a physician's prescription.
When discussing the nursing process, the instructor stresses that for clients undergoing cardiac surgery, it is important for the nurse to demonstrate competence. What is the rationale for this statement?
- A. To acknowledge the client's emotion
- B. To encourage verbal conversation
- C. To relieve the client's insecurity and anxiety
- D. To encourage the client to communicate
Correct Answer: C
Rationale: When the nurse is knowledgeable and competent, it relieves the client's insecurity and anxiety regarding the surgery.
The client is being prepared for cardiothoracic surgery and is very apprehensive. What medication can be administered with a physician's prescription to decrease the amount of anesthetic that the client will receive in surgery?
- A. An antipsychotic drug
- B. An anxiolytic drug
- C. An anticholinergic drug
- D. An analgesic
Correct Answer: B
Rationale: Anxiolytics may be used before surgery to lessen anxiety and sedate the client. Clients who are relaxed and sedated when anesthesia is given require a smaller dose of anesthetic. An antipsychotic would not be indicated for this client. An anticholinergic medication may be given to decrease the amount of secretions the client will have during surgery but will not decrease anxiety. An analgesic is normally given postoperatively for pain control.
A client is in the intensive care unit with a diagnosis of severe uncontrolled hypertension. What method of monitoring would best meet the needs of this client?
- A. Central venous pressure monitoring
- B. Direct blood pressure monitoring
- C. Pulmonary artery pressure monitoring
- D. Manual blood pressure readings with a sphygmomanometer
Correct Answer: B
Rationale: Direct blood pressure monitoring continuously displays the waveform and indicates the client's systolic, diastolic, and mean arterial pressures. This type of equipment eliminates the need to auscultate the BP. Direct BP monitoring may be used in clients with severe and sustained hypertension or hypotension and during and after cardiac surgery. Central venous pressure monitoring would be used to detect an excess or deficit in venous blood volume and would not be indicated for this client. Pulmonary artery pressure monitoring aids in the early treatment of fluid imbalances prevents left-sided heart failure or promotes its early correction and helps monitor the client's response to treatment and would not be indicated for this client. A manual reading is dependent on who takes the BP and can vary in its readings. It is not as accurate as the direct blood pressure monitoring.
A client has experienced a myocardial infarction (MI). After the acute stage of the MI, what is the most lethal complication the nurse should be aware can occur?
- A. Thrombophlebitis
- B. Ventricular aneurysm
- C. Mitral valve prolapse
- D. Septic shock
Correct Answer: B
Rationale: A ventricular aneurysm is the most lethal complication among clients who survive the acute stage of a myocardial infarction (MI). Thrombophlebitis is a complication of immobility. Mitral valve prolapse is an acquired disorder that is not a complication from having an MI. Cardiogenic shock, not septic shock, is a complication after sustaining an MI.