Cardiovascular Disorders EAQ 14

The nurse is teaching a nursing student about maternal cardiac risk groups and mortality rates. Which statement correctly describes the risk groups and mortality rates? 1. "Aortic stenosis has a mortality rate of 5% to 15%." 2. "Pulmonary hypertension is categorized as group I." 3. "Patent ductus arteriosus is categorized as group II." 4. "Artificial heart valves have a mortality rate of less than 1%."

1. "Aortic stenosis has a mortality rate of 5% to 15%." Maternal cardiac risk is classified into three groups: group I with a mortality rate of less than 1%, group II with a mortality rate between 5% to 15%, and group III with a mortality rate between 25% to 50%. Aortic stenosis is categorized under group II; hence it has the mortality rate of 5% to 15%. Pulmonary hypertension is categorized under group III. Patent duct arteriosus is included under group I. Artificial heart valve is in group II with a mortality rate of 5% to 15%.

What risks does the nurse expect to find in a pregnant client with a large ventricular septal defect? Select all that apply. 1. Arrhythmias 2. Heart failure 3. Aortic dissection 4. Infective endocarditis 5. Pulmonary hypertension

1. Arrhythmias 2. Heart failure 5. Pulmonary hypertension A ventricular septal defect is an abnormal opening between the left and right ventricles. The defect may lead to various complications, such as arrhythmias, heart failure, and pulmonary hypertension in pregnant women due to the changes in venous return. Aortic dissection is a complication caused by coarctation of the aorta. Infective endocarditis is not associated with a large ventricular septal defect.

The nurse is caring for a pregnant client with an arrhythmia. Which medication would be the safest to administer? 1. Digoxin (Lanoxin) 2. Verapamil (Calan) 3. Quinidine (Quinidex) 4. Lidocaine (Xylocaine)

1. Digoxin (Lanoxin) Digoxin (Lanoxin) has shown no evidence of producing unfavorable side effects on the fetus. Therefore, the drug can be used to treat an arrhythmia in the client. Limited data are available regarding verapamil (Calan). Therefore, prescribing verapamil (Calan) to the client may not be safe and may cause teratogenic effects. Quinidine (Quinidex) may cause transient neonatal thrombocytopenia and damage to the eighth cranial nerve. There is no evidence that lidocaine (Xylocaine) has unfavorable side effects on the fetus, but high serum levels may cause central nervous system (CNS) depression at birth. Therefore, verapamil (Calan), quinidine (Quinidex), and lidocaine (Xylocaine) should not be prescribed to the client.

A nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? 1. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. 2. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics. 3. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. 4. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

1. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a woman with cardiac disease because it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. Using the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.

What are the subjective symptoms of cardiac decompensation in a pregnant client? Select all that apply. 1. Palpitations 2. Cyanosis of the lips 3. Rapid respiration 4. Difficulty breathing 5. Feeling of smothering

1. Palpitations 4. Difficulty breathing 5. Feeling of smothering Subjective symptoms are those that the client experiences, but are not observable or measurable. Palpitations, difficulty breathing, and a feeling of smothering are the subjective symptoms related to cardiac decompensation. These symptoms cannot be measured or observed. Objective signs are those that can be observed and measured. These include cyanosis of the lips and rapid respiration.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: 1. Orthopnea 2. Decreasing energy levels 3. Moist frequent cough and frothy sputum 4. Crackles (rales) at the bases of the lungs on auscultation

2. Decreasing energy levels Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. Orthopnea is a finding that appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Moist frequent cough and crackles and rales appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.

The nurse is caring for a pregnant client with rheumatic heart disease (RHD) and activity intolerance. Which nursing interventions should the nurse perform to reduce activity intolerance? Select all that apply. 1. Monitor fluid intake and output. 2. Teach the client to lie on her side. 3. Advise the client to maintain an activity log. 4. Encourage the client to reduce activity that causes fatigue. 5. Help the client develop an individualized program of activity and rest.

3. Advise the client to maintain an activity log. 4. Encourage the client to reduce activity that causes fatigue. 5. Help the client develop an individualized program of activity and rest. The nurse should advise the client to maintain an activity log to evaluate effectiveness and adherence to the activity program. Reducing activities that cause fatigue prevents injury to the fetus. An individualized program of activity and rest helps maintain the client's cardiac output. The nurse should teach the client to lie on her side to increase cardiac output, because this also helps prevent supine hypotension. The nurse should monitor the intake and output of fluid to assess renal complications and to prevent hypertension in the client. These interventions would not help to improve activity tolerance in the client.

The nurse is assessing a pregnant client with a cardiac disorder. After the assessment, the nurse informs the primary health care provider that the client is symptomatic, with marked limitation of activity. Which class of cardiac disorder does the client have according to the New York Heart Association (NYHA)? 1. Class I 2. Class II 3. Class III 4. Class IV

3. Class III The New York Heart Association's (NYHA) functional classification of organic heart disease is based on the degree of disability due to cardiac disease in the client. The cardiac diseases that are symptomatic with marked limitation of activity are grouped under class III cardiac diseases.Cardiac diseases grouped under class I are characterized as being asymptomatic without limitation of physical activity.Class II cardiac diseases include symptomatic diseases with slight limitation of activity. Cardiac diseases grouped under class IV are symptomatic and cause an inability to carry out physical activity without discomfort.

The primary health care provider identifies a risk of right-sided heart failure in a pregnant client with atrial septal defect. What is the cause of the risk in this client? 1. Ruptured aorta 2. Stiffened valve leaflets 3. Increased plasma volume 4. Increased pressure in pulmonary veins

3. Increased plasma volume An atrial septal defect is characterized by an abnormal opening between the atria. Some pregnant clients with atrial septal defect may have right-sided heart failure or arrhythmias, due to increased plasma volume. A ruptured aorta is caused by coarctation of the aorta. The rupture is not a cause for right-sided heart failure in clients with an atrial septal defect. Stiffening of valve leaflets may cause mitral valve stenosis. Pulmonary hypertension is not a cause for right-sided heart failure in clients with atrial septal defect during pregnancy.

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of what problem? 1. Euglycemia 2. Rheumatic fever 3. Pneumonia 4. Cardiac decompensation

4. Cardiac decompensation Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. Rheumatic fever can cause heart problems, but it does not present with these symptoms. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms.

The nurse is caring for a pregnant client diagnosed with mitral valve stenosis. Which position would the nurse suggest to the client to ensure a safe labor? 1. Supine 2. Standing 3. Lithotomy 4. Sidelying

4. Sidelying Mitral valve stenosis occurs for various reasons, such as a stiffening of the valve leaflets resulting from rheumatic heart disease. During labor for clients with mitral valve stenosis, it is very important to have adequate pain control to prevent tachycardia. A sidelying position is desired in these clients to prevent tachycardia. A supine position does not provide comfort; rather, it may cause supine hypotension in the client. A standing position is not preferred in clients with mitral valve stenosis. The lithotomic position may increase the risk of pulmonary edema in clients with mitral valve stenosis.