Nokea
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what?
- A. Cardiac tamponade
- B. Left ventricular hypertrophy
- C. Right-sided heart failure
- D. Ventricular insufficiency
Correct Answer: B
Rationale: Aortic regurgitation eventually causes left ventricular hypertrophy. In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood. Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.
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A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient?
- A. Aortic regurgitation
- B. Mitral stenosis
- C. Mitral valve prolapse
- D. Aortic stenosis
Correct Answer: B
Rationale: The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.
A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient?
- A. Patients generally stay in the hospital for 6 to 8 days.
- B. Patients are kept in the hospital until they are independent with all aspects of their care.
- C. Patients need to stay in the hospital until they regain normal heart function for their age.
- D. Patients usually remain at the hospital for 24 to 48 hours.
Correct Answer: D
Rationale: After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.
A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?
- A. Exposure to immunocompromised individuals
- B. Future hospital admissions
- C. Dental procedures
- D. Live vaccinations
Correct Answer: C
Rationale: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.
The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications?
- A. The nurse keeps the patient isolated to prevent nosocomial infections.
- B. The nurse encourages coughing and deep breathing.
- C. The nurse helps the patient with activities until the pain and fever subside.
- D. The nurse encourages increased fluid intake until the infection resolves.
Correct Answer: C
Rationale: To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patients condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated. Due to pain, coughing and deep breathing are not normally encouraged. An increase in fluid intake is not always necessary.
A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following?
- A. The need for regularly scheduled testing of the patients International Normalized Ratio (INR)
- B. The need to learn to sleep in a semi-Fowlers position for the first 6 to 8 weeks to prevent emboli
- C. The need to avoid foods that contain vitamin K
- D. The need to take enteric-coated ASA on a daily basis
Correct Answer: A
Rationale: Patients who take warfarin (Coumadin) after valve replacement have individualized target INRs; usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement. Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping upright is unnecessary.