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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.
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Before administering digoxin to a client with valvular disease, the nurse assesses the apical heart rate as 62 beats/minute. The client's usual rate ranges between 66 to 72 beats/minute. Which is the best action for the nurse to take?
- A. Hold the digoxin.
- B. Recheck the apical pulse in 30 minutes.
- C. Administer the digoxin.
- D. Notify the physician.
Correct Answer: C
Rationale: A heart rate of 62 beats/minute falls within the normal range for administration of this drug. Holding the medication would not be recommended unless a specific prescription was detailed to do so. The nurse may decide to recheck the pulse but this is not required. Notifying the physician of normal findings is not efficient use of time or resources.
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.
The nurse is interviewing a client who is being admitted for possible mitral regurgitation. Which historical fact is of greatest value to the nurse?
- A. Congenital neural tube defect
- B. Rheumatic fever
- C. One-pack-a-day smoker for 20 years
- D. Pacemaker inserted 2 years ago
Correct Answer: B
Rationale: Rheumatic fever and subsequent heart disease is the prominent cause of valvular insufficiency. Congenital neural tube defect is associated with spina bifida not mitral regurgitation. Smoking and insertion of pacemaker are significant to heart disorders but not of greatest value as rheumatic fever.
A client with aortic valve regurgitation is asking about the disease process. What would the nurse tell the client is the first sign of aortic valve regurgitation?
- A. Tachycardia
- B. Left-sided heart failure
- C. Pain
- D. Dysrhythmias
Correct Answer: A
Rationale: Tachycardia is one of the first signs of cardiac compensation. When valve damage affects the left ventricle, the client becomes aware of forceful heart contractions (palpitations). At first, palpitations occur only when lying flat or on the left side. Aortic valve regurgitation does not produce left-sided heart failure, pain, or dysrhythmias as the first symptom of disease.
A client who is diagnosed with aortic stenosis is scheduled for a percutaneous balloon valvuloplasty. Which statement does the nurse include when reinforcing education regarding this procedure?
- A. The balloon is placed in your heart valve and inflated.
- B. A chest incision is necessary for the scheduled procedure.
- C. You will require hospitalization for several days after the procedure.
- D. The opening from this procedure is likely to close in approximately 1 year.
Correct Answer: A
Rationale: Percutaneous balloon valvuloplasty (i.e., valvotomy) is a nonsurgical alternative for the treatment of mitral stenosis. During this procedure, a catheter with an uninflated balloon is passed through the femoral vein and threaded into the right atrium. The septum is then punctured between the right and left atria. When the catheter is in the mitral valve, it is inflated; therefore, the statement the nurse includes when reinforcing education with this client regarding this procedure is 'The balloon is placed in your heart valve and inflated.' The other statements are not appropriate for the nurse to include when reinforcing education because this procedure is nonsurgical, thus will not require a chest incision; the client is likely to be discharged the same day as the procedure, and the opening that is caused as a result of this procedure is likely to close within 6 months, not 1 year.