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The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?
- A. To eat a small meal before taking nitroglycerin
- B. To drink a glass of milk before taking nitroglycerin
- C. To engage in 15 minutes of light exercise before taking nitroglycerin
- D. To rest and relax before taking nitroglycerin
Correct Answer: D
Rationale: The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.
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The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite?
- A. The procedure can be performed on an outpatient basis in a physicians office.
- B. Repaired valves tend to function longer than replaced valves.
- C. The procedure is not associated with a risk for infection.
- D. Lower doses of antirejection drugs are required than with valve replacement.
Correct Answer: B
Rationale: In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation. Valvuloplasty carries a risk of infection, like all surgical procedures, and it is not performed in a physicians office. Antirejection drugs are unnecessary because foreign tissue is not introduced.
The nurse is preparing a patient for cardiac surgery. During the procedure, the patients heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?
- A. Orthotopic transplant
- B. Xenograft
- C. Heterotropic transplant
- D. Homograft
Correct Answer: A
Rationale: Orthotopic transplantation is the most common surgical procedure for cardiac transplantation. The recipients heart is removed, and the donor heart is implanted at the vena cava and pulmonary veins. Some surgeons still prefer to remove the recipients heart, leaving a portion of the recipients atria (with the vena cava and pulmonary veins) in place. Homografts, or allografts (i.e., human valves), are obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement. Xenografts and heterotropic transplantation are not terms used to describe heart transplantation.
A cardiac surgery patients new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurses most appropriate action?
- A. Prepare to assist with pericardiocentesis.
- B. Reposition the patient into a prone position.
- C. Administer a dose of metoprolol.
- D. Administer a bolus of normal saline.
Correct Answer: A
Rationale: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.
The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patients diagnosis?
- A. Mitral valve regurgitation
- B. Aortic stenosis
- C. Aortic regurgitation
- D. Mitral valve stenosis
Correct Answer: D
Rationale: Because no valve protects the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails. None of the other listed valvular disorders has this pathophysiological effect.
A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patients symptoms, the nurse should teach the patient to do which of the following?
- A. Eat a high-protein, low-carbohydrate diet.
- B. Avoid activities that cause an increased heart rate.
- C. Avoid large crowds and public events.
- D. Perform deep breathing and coughing exercises.
Correct Answer: B
Rationale: Patients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.