Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition - Caring for Clients With Valvular Disorders of the Heart

Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition - Caring for Clients With Valvular Disorders of the Heart Related

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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.

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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 mitral stenosis develops a productive cough with pink, frothy sputum. The best interpretation made by the nurse would be to further evaluate for which complication?

  • A. Pulmonary edema
  • B. Congestive failure
  • C. Thrombophlebitis
  • D. Cardiogenic shock
Correct Answer: A

Rationale: A cough with productive, pink, frothy sputum and crackles in the bases of the lungs are signs of pulmonary congestion. Pink, frothy sputum would not be present in congestive failure, thrombophlebitis, or cardiogenic shock.

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.

The nurse is providing teaching to a post-valve replacement client. Which activit(ies) would require prophylactic antibiotic use? Select all that apply.

  • A. Vision screening
  • B. Dental care
  • C. Echocardiogram
  • D. MRI
  • E. Colonoscopy
  • F. Chelation therapy
Correct Answer: B,E

Rationale: Dental cleaning/care and colonoscopy are invasive procedures that can disturb the normal bacteria located in residence and place a valve replacement client at risk for infective endocarditis. Vision screening, echocardiogram, MRI, and chelation therapy are not invasive procedures and do not mobilize bacteria.

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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