Nokea
The nurse is caring for a client with mitral stenosis. Which assessment finding would cause the greatest concern in providing nursing care to this client?
- A. Decreased pulmonary pressure
- B. Increased cardiac output
- C. Decreased right ventricular pressure
- D. Increased left atrial pressure
Correct Answer: A
Rationale: A damaged mitral valve leads to incomplete emptying of the left atrium and accumulation of blood resulting in increased pressure. As the backup of blood continues, pressure is increased into the lungs and right ventricle and cardiac output decreases.
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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.
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.
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.
The nursing instructor is teaching the junior nursing students about aortic regurgitation. What classification of drugs is used to sustains the client with aortic regurgitation?
- A. Antihypertensives
- B. Anticoagulants
- C. Cardiac glycosides
- D. Antiarrhythmics
Correct Answer: C
Rationale: Because aortic regurgitation is mild and only slowly progressive in most people, clients are sustained with cardiac glycosides or beta-blockers and diuretics. Antihypertensives, anticoagulants, and antiarrhythmics are not the type of drugs used to treat aortic regurgitation.
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.