Chapter 24-Caring for Clients with Valvular Disorders of the Heart- NCLEX

A 37-year-old client is undergoing diagnostics for a cardiac disorder. As a child, the client had rheumatic fever and her recent pregnancy seems to have exacerbated her fatigue and dyspnea after exertion. After a thorough examination, the cardiologist schedules her for a corrective procedure. What could have been the earliest indication of Pam's valvular disorder?

Changes in her heart sounds

Most people who have mitral valve prolapse never have any symptoms. Other patients with the diagnosis of mitral valve prolapsed do have symptoms. What symptoms might a patient have with mitral valve prolapse? (Mark all that apply.)

Chest pain Fatigue Palpitations

A 38-year-old client has a several-year history of asymptomatic mitral valve regurgitation. The client inquires about continuing regular exercise. As her nurse, which of the following responses is appropriate?

Continue exercise until mild symptoms develop.

What instruction should be included in the teaching plan for a client with aortic stenosis?

Eliminate smoked or processed meats.

A patient at the clinic describes shortness of breath, periods of feeling "lightheaded," and feeling fatigued despite a full night's sleep. The nurse obtains vital signs and auscultates a systolic click. What does the nurse suspect from the assessment findings?

Mitral valve prolapse

A patient comes into the emergency room complaining about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which of the following diagnoses?

Pericarditis

Which of the following mitral valve conditions generally produces no symptoms?

Prolapse

What is the primary reason that the nurse monitors urine output in the client with a valvular disorder of the heart?

Renal output reflects the heart's ability to perfuse the renal arteries.

When auscultating the heart of a client with mitral regurgitation, the nurse would expect to hear:

a diminished S1.

A client with no history of cardiac problems is undergoing diagnostics for a cardiac valvular condition. The cardiologist has indicated that the client has had this particular valvular condition from birth, and the recent onset of symptoms is attributed to age. What disorder is causing the client difficulty?

aortic stenosis

A client with a history of cardiac valve disorder reports chest pain. Assessment reveals no emergency but symptomology consistent with angina secondary to mitral valve prolapse. The nurse instructs the client to lie flat and elevate legs at a 90° angle for 3 to 5 minutes. What physical response does this nursing intervention facilitate?

changes in blood volume in the heart

A client with aortic stenosis is at a greater risk for falls because:

dizziness and fainting are symptoms.

The cardiologist determines that a client with aortic stenosis is a candidate for TAVI. The client is confused and afraid of "open heart surgery." How does the nurse instructs the client by:

explaining that the cardiologist will access the stenotic valve through a catheter.

A client with suspected mitral valve stenosis is undergoing diagnostic testing. The earliest indication of this client's valvular disorder was most likely changes in:

heart sounds

A client with suspected mitral valve stenosis is undergoing diagnostic testing. The earliest indication of this client's valvular disorder was most likely changes in:

heart sounds.

A client with mitral stenosis asks the nurse why antibiotics are needed in addition to the other drugs the client is taking. The nurse instructs the client that the antibiotics will:

help prevent infective endocarditis.

In addition to age, what else is a risk factor for aortic stenosis?

history of infective endocarditis

Clients with valvular disorders who are taking prescribed anticoagulants should be instructed about which possible side effects

increased bleeding time

The chest radiograph of a client who is experiencing fatigue and dyspnea after slight exertion reveals an enlarged left atrium and mitral valve calcification. The findings most likely indicate:

mitral stenosis.

Upon auscultation of a client's heart, the examiner hears a very faint murmur when the client is in certain positions. How would the nurse expect this murmur to be graded?

1

Upon auscultation of a client's heart, the examiner hears a quiet murmur. How would the nurse expect this murmur to be graded?

2

The nurse is monitoring the prothrombin time (PT) of a client taking anticoagulant therapy. Which of the following values would the nurse consider normal?

2.5

Upon auscultation of a client's heart, the examiner hears a moderately loud murmur. How would the nurse expect this murmur to be graded? Fill in the blank with a number.

3

Upon auscultation of a client's heart, the examiner hears a loud murmur accompanied by a palpable thrill. How would the nurse expect this murmur to be graded?

4

Upon auscultation of a client's heart, the examiner hears a very loud murmur that also is audible with the stethoscope partly off the chest. How would the nurse expect this murmur to be graded? Fill in the blank with a number.

5

Upon auscultation of a client's heart, the examiner hears a very loud murmur. The examiner removes the stethoscope completely and can still hear the murmur. How would the nurse expect this murmur to be graded? Fill in the blank with a number.

6

A client has just undergone percutaneous balloon valvuloplasty. The nurse knows that the client will undergo an echocardiogram within

72 hrs

A 70-year-old client in the cardiac unit has been admitted for diagnostics to determine the etiology and treatment for her cardiac valvular disorder. Which of the following events could have affected her valvular function? Choose all correct options.

Age-related degeneration MI

The nurse advises a client with mitral valve prolapse to avoid the use of alcohol. What is the primary reason for this restriction?

Alcohol can suppress antidiuretic hormone (ADH), leading to loss of extracellular fluid

A nursing student is taking a test on the cardiovascular system. Which of the following would the student correctly identify as cardiac valves? Select all that apply.

Aortic Pulmonic Tricuspid Mitral

The nurse is taking the radial pulse of a client with a suspected valvular disorder. The pulse is very strong, with quick, sharp beats followed by a sudden collapse of force. What condition would the nurse suspect in the client?

Aortic regurgitation

A nurse is using a diagram (see attached) to explain a client's valvular disorder to her and her family. Which disorder is consistent with the accompanying diagram?

Aortic stenosis

A patient with mitral stenosis exhibits symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm

Atrial fibrillation

A patient with mitral stenosis exhibits symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm?

Atrial fibrillation

You are receiving a patient with aortic regurgitation from the critical care unit into the step-down unit. You are aware that aortic regurgitation causes what?

Blood to flow back from the aorta to the left ventricle

you are receiving a patient with aortic regurgitation from the critical care unit into the step-down unit. You are aware that aortic regurgitation causes what?

Blood to flow back from the aorta to the left ventricle

A 29-year-old male with a history of cardiac valve disorder calls you to his hospital bed reporting chest pain. Your thorough assessment reveals no emergency but symptomology consistent with his angina secondary to his mitral valve prolapse. You instruct him to lie flat and elevate his legs at a 90 angle for 3 to 5 minutes. What physical response does this nursing intervention facilitate

Blood volume changes in the heart

A 29-year-old male with a history of cardiac valve disorder calls you to his hospital bed reporting chest pain. Your thorough assessment reveals no emergency but symptomology consistent with his angina secondary to his mitral valve prolapse. You instruct him to lie flat and elevate his legs at a 90 angle for 3 to 5 minutes. What physical response does this nursing intervention facilitate?

Blood volume changes in the heart

When instructing a patient on a no added salt diet, the nurse should instruct the patient on foods with hidden salt. Which of the following foods have hidden salt and should be avoided?

Canned soup

The nurse is aware that the following finding is often the earliest indication of mitral stenosis:

Changes in heart sounds

A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection?

Cyclosporine

A patient on the cardiac unit asks the nurse what the first symptoms of mitral stenosis are. When discussing the clinical manifestations of mitral stenosis with this patient, it would be important for the nurse to emphasize what?

Difficulty breathing

The staff educator is presenting a workshop on valvular disorders. When discussing the pathophsiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what?

Left ventricular enlargement

Which of the following dietary recommendations should a nurse give a patient with mitral valve prolapse to compensate for symptoms associated with hypovolemia?

Liberal fluid intake

You are caring for a patient who is scheduled to undergo a valvuloplasty to repair a defective heart valve. You would include in your patient education which priority area?

Long-term anticoagulant therapy

Diagnostic testing reveals a backflow of blood in the client's left ventricle from the left atrium. The nurse is aware that the patient is suffering from a defect in which valve?

Mitral

A 37-year-old client is undergoing diagnostics for a cardiac disorder. As a child, she had rheumatic fever and her recent pregnancy seems to have exacerbated her fatigue and dyspnea after exertion. After a thorough examination, the cardiologist schedules the client for a corrective procedure. What is her expected diagnosis?

Mitral stenosis

A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea as a result of pulmonary venous hypertension. What valvular disorder would cause pulmonary venous hypertension?

Mitral stenosis

Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic?

Reports of constant chest pain

A client has mitral regurgitation. Which of the following heart sounds does the nurse recognize as a sign of impending heart failure?

S3

The nurse is caring for a patient with acute pericarditis. What nursing management would be instituted to minimize complications

The nurse helps the patient with activity restrictions until the pain and fever subside.