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The nurse is caring for a client with a valvular disorder of the heart. What intervention should the nurse perform before administering the prescribed beta-blockers to clients with valvular disorders of the heart?
- A. Monitor the prothrombin time.
- B. Monitor for episodes of bleeding.
- C. Take the client's apical pulse.
- D. Monitor for bluish discoloration of the palms.
Correct Answer: C
Rationale: Before administering beta-blockers, the nurse should take the client's apical pulse. If the heart rate is less than 60 beats/minute, the nurse should withhold the drug and inform the primary healthcare provider. Oral anticoagulant therapy requires close monitoring of prothrombin time or INR. The nurse should also closely monitor clients receiving oral anticoagulants for episodes of bleeding. Overdosage of beta-blockers indicates bluish discoloration of the palms.
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A client is being evaluated for mitral stenosis versus mitral insufficiency. Which of the following symptoms would the nurse find in either condition?
- A. Angina
- B. Syncope
- C. Murmur
- D. High blood pressure
Correct Answer: C
Rationale: Mitral stenosis and mitral insufficiency both create regurgitation of blood back through the mitral valve which can be heard as a murmur. Angina and syncope are not common and would only be exhibited if decrease nourishment of the cardiac muscle and organs occur. Hypertension may be an underlying condition but not necessarily associated with both disorders.
When assessing a client, what sign would the nurse know is an early sign of an impending heart failure?
- A. S1 heart sound
- B. S3 heart sound
- C. Heart murmur
- D. Crackles
Correct Answer: B
Rationale: An S3 heart sound, if heard, is an early sign of impending heart failure. The S1 heart sound is normal. Heart murmur is not a sign of impending heart failure. Moist lung sounds could be indicative of either heart failure or pneumonia.
The nurse collects data for a client who is diagnosed with mitral stenosis with a murmur. In which position does the nurse place the client to auscultate the documented murmur?
- A. Prone
- B. Supine
- C. Left lateral
- D. Right lateral
Correct Answer: C
Rationale: Changes in heart sounds may be the earliest indication of mitral valve stenosis. S1 may be extremely loud if the cusps are fused or muffled or absent if the cusps have calcified and are immobile. A murmur, described as sounding like a rumbling underground train, can be heard at the heart's apex, especially when the client assumes a left lateral position. The other positions are not supported by evidence-based practice guidelines as appropriate positions in which to place the client to monitor a murmur.
A client with progressive mitral valve prolapse is experiencing sympathetic nervous system symptoms in addition to prolapse symptoms. Which teaching point should be stressed by the nurse to minimize these effects?
- A. Antibiotic therapy before invasive procedures
- B. Low-dose aspirin daily
- C. Avoid caffeine.
- D. Decrease fluid and sodium intake.
Correct Answer: C
Rationale: The symptoms associated with sympathetic nervous response (anxiety, agitation, nervousness, and palpitations) are often managed with antianxiety medications and advisement to avoid caffeine and over-the-counter medications that contain stimulants. Periodic antibiotic therapy use before an invasive procedure is not associated with sympathetic nervous system symptoms. Low-dose aspirin is used to prevent thrombus formation. Decreasing fluid and sodium intake is indicated for the control of congestive failure.
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.