Nokea
The nurse is caring for a client who just received a percutaneous balloon valvuloplasty for the treatment of mitral stenosis. For which finding should the nurse assess?
- A. Rejection of porcine graft
- B. Mitral regurgitation
- C. Infection at incision site
- D. Blood shunting from right to left atrium
Correct Answer: B
Rationale: The balloon valvuloplasty stretches the valve and can impair the papillary muscles, resulting in regurgitation of blood back through the mitral valve. A percutaneous balloon valvuloplasty does not have an incision and does not use a porcine graft. The septum is perforated and can allow shunting of blood but the shunting, if occurs, will move from left to right.
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The nurse is caring for a client with a valvular disorder. The client is at risk for decreased cardiac output. What nursing intervention should a nurse perform for this client?
- A. Perform exercises consistently.
- B. Keep legs horizontal.
- C. Auscultate lung and heart sounds.
- D. Measure urine output.
Correct Answer: D
Rationale: The nurse should monitor urine output every 8 hours or more often if it is less than 500 mL/day. Renal output reflects the heart's ability to perfuse the renal arteries. The client should not perform any exercises and should be on bed rest. Keeping the client's legs horizontal and auscultating lung and heart sounds will not help in this condition.
The nurse is caring for a client diagnosed with mitral stenosis. Which client symptom change would most likely indicate to the nurse, a progression of this condition?
- A. Decreased systolic pressure
- B. Increased systolic pressure
- C. Widening pulse pressure
- D. Normal diastolic pressure
Correct Answer: A
Rationale: As mitral stenosis progresses, the systolic blood pressure will decrease due to the reduction of the cardiac output. Widening pulse pressure with normal diastolic pressure is associated more with aortic regurgitation.
The nurse provides care for an older adult client who is diagnosed with valvular heart disease. On auscultation of the client's heart sounds, the nurse notes an erratic heart rhythm. Which age-related change is the most likely cause for this finding?
- A. A stiffening of the aorta
- B. A decrease in metabolism
- C. An increase in thirst sensation
- D. A thinning of the mitral valve
Correct Answer: A
Rationale: Age-related effects, such as stiffening of the aorta, calcification, and fibrotic thickening (not thinning) of the mitral and aortic valves, contribute to development of symptoms (e.g., increased systolic blood pressure [BP], dangerous arrhythmias [erratic heart rhythms or rates that are too fast or slow] sometimes referred to as dysrhythmias) and complications (e.g., increased myocardial oxygen demand, heart failure, and alterations in cardiac output) in the older adult with valvular heart disease. A decrease in metabolism is an age-related effect for clients with valvular heart disease; however, this affects the dosage of prescribed medication and is not the cause of the client's dysrhythmia. A decrease, not increase, in thirst sensation is an age-related change that could lead to dehydration, and, thus, changes in the client's heart rhythm.
What disease process is mitral regurgitation associated with?
- A. Aortic stenosis
- B. Cellulitis
- C. Pulmonary fibrosis
- D. Rheumatic carditis
Correct Answer: D
Rationale: Mitral regurgitation is associated with rheumatic carditis and mitral valve prolapse. It is not associated with aortic stenosis, cellulitis, or pulmonary fibrosis. Aortic stenosis is a narrowing of the aortic valve, not related to the mitral valve. Cellulitis is inflammation in tissue, and pulmonary fibrosis is a scarring in the tissue of the lung.
What nutritional intervention would be appropriate for a client with a valvular disorder?
- A. Limit sodium intake.
- B. Eat six small meals a day.
- C. Limit caloric intake to maintain optimal weight.
- D. Increase intake of B and C vitamins.
Correct Answer: A
Rationale: Clients with valvular disorders often need to limit sodium intake because decreasing the volume of blood decreases cardiac workload. Eating six small meals daily, limiting caloric intake, and increasing the intake of B and C vitamins would not help a client with a valvular disorder.