Nokea
The nurse is caring for a patient who is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which of the following information should the nurse include?
- A. Biological replacement valves require the use of immunosuppressive drugs.
- B. Mechanical mitral valves require replacement approximately every 5 years.
- C. Lifelong anticoagulant therapy is needed after mechanical valve replacement.
- D. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.
Correct Answer: C
Rationale: Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than 5 years. All valve repair procedures are palliative, not curative, and require lifelong health care. Biological valves do not activate the immune system, and immunosuppressive therapy is not needed.
You may also like to solve these questions
The nurse is assessing a patient with mitral valve stenosis and hypoxemia. Which of the following findings should the nurse expect to assess?
- A. Diastolic murmur
- B. Peripheral edema
- C. Right upper quadrant tenderness
- D. Complaints of shortness of breath
Correct Answer: D
Rationale: The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease, but are not indicators of possible hypoxemia.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. Which of the following actions is best for the nurse to implement?
- A. Force fluids to 3000 ml to decrease fever and inflammation.
- B. Teach about deep, slow respirations to control the pain.
- C. Remind the patient to ask for the opioid pain medication every 4 hours.
- D. Position the patient in Fowler's position, leaning forward on the overbed table.
Correct Answer: D
Rationale: Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep respirations tends to increase pericardial pain. Opioids are not very effective at controlling pain caused by acute inflammatory conditions and are usually ordered PRN. The patient would receive scheduled doses of a nonsteroidal anti-inflammatory drug (NSAID).
The nurse is conducting an admission health history with a patient with possible rheumatic fever. Which of the following questions is most pertinent to ask?
- A. Have you had a recent sore throat?
- B. Are you using any illegal IV drugs?
- C. Do you have any family history of congenital heart disease?
- D. Can you recall having any chest injuries in the last few weeks?
Correct Answer: A
Rationale: Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit intravenous (IV) drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever and would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.
The nurse is caring for a patient with rheumatic fever who has subcutaneous nodules, erythema marginatum, and polyarthritis. Which of the following nursing diagnoses best reflects these findings?
- A. Activity intolerance related to physical deconditioning (arthralgia)
- B. Risk for infection as evidenced by immunosuppression
- C. Chronic pain related to injury agent (permanent joint fixation)
- D. Risk for impaired skin integrity evidenced by pressure over bony prominence
Correct Answer: A
Rationale: The patient's joint pain will lead to difficulty with activity. The skin lesions seen in rheumatic fever are not open or pruritic and thus do not pose a high risk for infection. Although acute joint pain will be a problem for this patient, joint inflammation is a temporary clinical manifestation of rheumatic fever and is not associated with permanent joint changes.
The nurse is assessing a patient with infective endocarditis (IE). Which of the following findings should the nurse expect to assess?
- A. A new regurgitant murmur
- B. A pruritic rash on the trunk
- C. Involuntary muscle movement
- D. Substernal chest pain and pressure
Correct Answer: A
Rationale: New regurgitant murmurs occur in IE because vegetation on the valves prevents valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.