Chapter 16 Pellico- PREPU
After a new graduate nurse completes an assessment of a patient with mitral regurgitation, she approaches her preceptor to report her findings. Which of the following statements represents the appropriate physical findings for a patient with mitral regurgitation? "I auscultated a mitral click." "The high-pitched blowing sound at the apex is indicative of a systolic murmur." "I heard a low-pitched diastolic murmur at the apex." "I knew I would hear a diastolic murmur at the left sternal border."
"The high-pitched blowing sound at the apex is indicative of a systolic murmur." Explanation: A systolic murmur is heard as a high-pitched, blowing sound at the apex. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath on exertion, and cough from pulmonary congestion also occur. All the others are not present with mitral regurgitation.
A nursing student is assigned to a patient with a mechanical valve replacement. The patient asks the student, "Why do I have to take antibiotics before getting my teeth cleaned?" Which response by the nursing student is most appropriate? "You are at risk of developing an infection in your heart." "Your teeth will not bleed as much if you have antibiotics." "This procedure may cause your valve to malfunction." "Antibiotics will prevent vegetative growth on your valves."
"You are at risk of developing an infection in your heart." Explanation: The patient is at risk for endocarditis and should take prophylactic antibiotics before any invasive procedure. Antibiotics have nothing to do with how much the teeth bleed. Cleaning of the teeth will not cause the valve to malfunction. Using the word "vegetative" with the patient may not be understood; therefore, it is not the most appropriate answer.
A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider. 2.6 3.0 3.4 3.8
3.8 Explanation: Coumadin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.
A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? A client 4 days postoperative after mitral valve replacement A client with hypertrophic cardiomyopathy A client with a history of repaired ventricular septal defect A client 1 day post coronary stent placement
A client 4 days postoperative after mitral valve replacement Explanation: Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired ventricular septal defects are moderate risks for infective endocarditis. Coronary stent placement isn't a risk factor for infective endocarditis.
The nurse is obtaining a history from a patient diagnosed with hypertrophic cardiomyopathy. What information obtained from the patient is indicative of this form of cardiomyopathy? A history of alcoholism A history of amyloidosis A parent has the same disorder A long-standing history of hypertension
A parent has the same disorder Explanation: Hypertrophic cardiomyopathy (HCM) is a rare autosomal dominant condition, occurring in men, women, and children (often detected after puberty) with an estimated prevalence rate of 0.05% to 0.2% of the population in the United States (Sander, 2011). Echocardiograms may be performed every year from 12 to 18 years of age and then every 5 years from 18 to 70 years of age in susceptible individuals (i.e., those with a family history of HCM) (Sander, 2011).
Antibiotic prophylaxis is recommended for the prevention of infective endocarditis (IE). The nurse must advise the patient with which of the following medical condition that prophylaxis is essential? Mitral valve prolapse A prosthetic valve Rheumatic heart disease A functional murmur
A prosthetic valve Explanation: Based on recent research (2008), the American Heart Association has revised its recommendations for antibiotic prophylaxis. Currently, there are four categories: previous infective endocarditis, a prosthetic valve, congenital heart disease with persistent risk of IE, and cardiac transplant recipients with cardiac valve diseases. Refer to Box 16-4 in the text.
The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse? Fatigue An extra heart sound Dizziness Syncope
An extra heart sound Explanation: Often, the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapsed.
The following are symptoms associated with aortic stenosis (AS): Angina, syncope, and dyspnea Diastolic murmur, syncope, dyspnea Syncope, diastolic murmur, angina Dyspnea, angina, diastolic murmur
Angina, syncope, and dyspnea Explanation: A triad of symptoms is associated with AS: (a) angina due to left ventricular hypertrophy and diminished coronary blood flow, (b) dyspnea due to heart failure, and (c) syncope, in particular with exertion, due to fixed cardiac output. A diastolic murmur is characteristic of aortic regurgitation, whereas a systolic ejection murmur is commonly heard with aortic stenosis.
The medical plan of treatment for chronic mitral regurgitation would include medications to reduce afterload, such as: Diuretics Angiotensin-converting enzyme (ACE) inhibitors. Vasodilators. Anticoagulants.
Angiotensin-converting enzyme (ACE) inhibitors. Explanation: Afterload reduction refers to arterial dilation, which occurs with ACE inhibitors.
The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder? Mitral insufficiency Tricuspid insufficiency Tricuspid stenosis Aortic regurgitation
Aortic regurgitation Explanation: The pulse pressure (i.e., difference between systolic and diastolic pressures) is considerably widened in patients with aortic regurgitation. One characteristic sign is the water-hammer (Corrigan's) pulse, in which the pulse strikes a palpating finger with a quick, sharp stroke and then suddenly collapses.
The nurse is caring for a patient diagnosed with myocarditis. The nurse understands that which of the following is the hallmark of myocarditis? Cardiac muscle inflammation Chest pain Pericardial friction rub Shortness of breath
Cardiac muscle inflammation Explanation: Cardiac muscle inflammation that results in myocyte necrosis is the hallmark of myocarditis. Chest pain, a pericardial friction rub, and shortness of breath occur in pericarditis.
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? Cardiac tamponade Decreased venous pressure Hypertension Left ventricular hypertrophy
Cardiac tamponade Explanation: The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade (see Chapter 29).
When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom? Orthopnea Chest pain Dyspnea Fatigue
Chest pain Explanation: The most characteristic symptom of pericarditis is chest pain. The pain is typically persistent, sharp, pleuritic, and usually felt in the mid chest, although it also may be located beneath the clavicle, in the neck, or in the left trapezius region. The discomfort is usually fairly constant, but is aggravated by deep inspiration, coughing, lying down, or turning. It may be relieved with a forward-leaning or sitting position.
A patient has been diagnosed with fused mitral leaflets, causing a backward flow of blood. What type of procedure does the nurse know is commonly performed for this type of problem? Annuloplasty Commissurotomy Valve replacement Chordoplasty
Commissurotomy Explanation: The most common valvuloplasty procedure is commissurotomy. Each valve has leaflets; the site where the leaflets meet is called the commissure. Leaflets may adhere to one another and close the commissure (i.e., stenosis). Less commonly, leaflets fuse in such a way that in addition to stenosis, the leaflets also are prevented from closing completely, resulting in backward flow of blood (i.e., regurgitation). A commissurotomy is the procedure performed to separate the fused leaflets.
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? Dyspnea Constant chest pain Fatigue lasting more than 1 month Uncontrolled restlessness
Constant chest pain Explanation: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. Pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Reference:
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? Procardia Cyclosporine Calan Vancocin
Cyclosporine Explanation: Because of advances in surgical techniques and immunosuppressive therapies, heart transplantation is now a therapeutic option for patients with end-stage heart disease. Cyclosporine (Gengraf, Neoral, and Sandimmune) and tacrolimus (Prograf, FK506) are immunosuppressants that decrease the body's rejection of foreign proteins, such as transplanted organs.
A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur? Pansystolic, blowing, high-pitched Systolic, harsh, crescendo-decrescendo Diastolic, blowing, decrescendo Diastolic, rumbling, low-pitched
Diastolic, rumbling, low-pitched Explanation: Mitral stenosis causes a diastolic, rumbling, low-pitched murmur audible at the apex. A pansystolic, blowing, high-pitched murmur characterizes mitral insufficiency. A systolic, harsh, crescendo-decrescendo murmur occurs with aortic stenosis. A diastolic, blowing, decrescendo murmur accompanies aortic insufficiency.
Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply. Elevated white blood cell (WBC) count Elevated c-reactive protein Elevated erythrocyte sedimentation rate (ESR) Decreased sedimentation rate Decreased C-reactive protein
Elevated white blood cell (WBC) count Elevated c-reactive protein Elevated erythrocyte sedimentation rate (ESR) Explanation: Abnormal findings include anemia, elevated WBC counts, elevated ESR, and elevated c-reactive protein
A patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder? Serial enzyme studies Cardiac catheterization Echocardiogram Phonocardiogram
Echocardiogram Explanation: The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily.
Which signs and symptoms accompany a diagnosis of pericarditis? Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Low urine output secondary to left ventricular dysfunction Lethargy, anorexia, and heart failure Pitting edema, chest discomfort, and nonspecific ST-segment elevation
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure and pitting edema, result from acute renal failure.
A patient with a prosthetic heart valve is diagnosed with subacute infective endocarditis. The nurse knows that the majority of these infections are caused by: Group A, beta-hemolytic Streptococcus Pseudomonas aeruginosa Serratia marcescens Staphylococcus aureus
Group A, beta-hemolytic Streptococcus Explanation: Acute IE is often caused by Staphylococcus infection, and its onset is rapid, occurring within days to weeks. Subacute IE, usually caused by Streptococcus, occurs more slowly and its course is prolonged.
A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? Group A, beta-hemolytic streptococcus Pseudomonas aeruginosa Serratia marcescens Staphylococcus aureus
Group A, beta-hemolytic streptococcus Explanation: Acute rheumatic fever, which occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis (Chart 28-2). Patients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure.
Which of the following changes occur to the heart as a result of heart transplant? Heart beats slower than the natural heart Heart beats faster than the natural heart No significant changes noted in the heart Heart takes less time to increase the heart rate in response to exercise
Heart beats faster than the natural heart Explanation: The transplanted heart beats faster than the patient's natural heart, averaging 100 to 110 beats/minute, because nerves that affect heart rate have been severed. The new heart also takes longer to increase the heart rate in response to exercise. Coronary artery disease (CAD) is a common problem among heart transplant recipients.
During auscultation of a patient, the nurse suspects a diagnosis of mitral valve regurgitation when hearing which of the following? Mitral click High-pitched blowing sound at the apex Low-pitched diastolic murmur at the apex Diastolic murmur at the left sternal border
High-pitched blowing sound at the apex Explanation: A systolic murmur is heard as a high-pitched, blowing sound at the apex. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath on exertion, and cough from pulmonary congestion also occur. All of the others are not present with mitral regurgitation.
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? Hypertrophic Dilated Restrictive Arrhythmogenic right ventricular cardiomyopathy
Hypertrophic Explanation: Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.
The nurse is educating a patient about the care related to a new diagnosis of mitral valve prolapse. What statement made by the patient demonstrates understanding? "I will avoid caffeine, alcohol, and smoking." "I will take antibiotics before getting my teeth cleaned." "I shouldn't get a tattoo but I can get my tongue pierced." "I shouldn't get a tattoo but I can get my tongue pierced."
I will avoid caffeine, alcohol, and smoking." Explanation: In mitral valve prolapse, if dysrhythmias are documented and cause symptoms, the patient is advised to eliminate caffeine and alcohol from the diet and to stop the use of tobacco products.
A patient diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC) and evidencing persistent ventricular arrhythmias asks a nurse what the probable course of medical treatment would be. Which of the following is the most likely intervention? Pacemaker Implantable defibrillator Intra-aortic balloon pump Heart transplant
Implantable defibrillator Explanation: If the patient presents with heart block, a pacemaker may be necessary to alter the electrical stimulation of the muscle and prevent the forceful hyperdynamic contractions that occur with HCM. Implantable defibrillators are recommended if there is persistent cardiac dysfunction and/or ventricular arrhythmias, particularly with ARVC. Intra-aortic balloon pump, left ventricular assist devices, and consideration of heart transplantation may be necessary in the most severe cases.
What medication order would the nurse question for a patient being treated for pericarditis? Colchicine Indocin Ibuprofen Prednisone
Indocin Explanation: Analgesic medications and NSAIDs such as aspirin or ibuprofen (Motrin) may be prescribed for pain relief during the acute phase of pericarditis. These agents also hasten reabsorption of fluid in patients with rheumatic pericarditis. Indomethacin (Indocin) is contraindicated because it may decrease coronary blood flow. Colchicine (Colcrys) or corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or if the patient does not respond to NSAIDs. Colchicine also may be used instead of NSAIDs during the acute phase.
For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? Left ventricular dysfunction Angina Edema Dyspnea
Left ventricular dysfunction Explanation: Digoxin may be used to treat left ventricular dysfunction, and diuretics may be used for dyspnea. Nitrates may be prescribed for the treatment of angina, but must be used with caution due to the risk of orthostatic hypotension and syncope.
Ralph Wilson, is a 52-year-old client in the hospital unit where you practice nursing. He is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis? Maintain the client on bed rest Administer a prescribed antipyretic Elevate the client's head Eliminate all phone calls and visitors
Maintain the client on bed rest Explanation: The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing.
Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? Maintain the patient on bed rest Administer a prescribed antipyretic Elevate the patient's head Administer supplemental oxygen
Maintain the patient on bed rest Explanation: The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures like minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient's head to promote maximal breathing potential.
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 Mitral regurgitation Aortic stenosis Aortic regurgitation
Mitral valve prolapse Explanation: Most people with mitral valve prolapse never have symptoms. A few have fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, or anxiety. Fatigue may occur regardless of activity level and amount of rest or sleep. Often the first and only sign of mitral valve prolapse is an extra heart sound, referred to as a mitral click. A systolic click is an early sign that a valve leaflet is ballooning into the left atrium.
A nurse understands that a patient with hypertrophic cardiomyopathy (HCM) would not be treated with which of the following drug classifications? ACE inhibitors Aldosterone antagonists Beta-blockers Nitrates
Nitrates Explanation: Nitrates should be avoided in HCM to maintain cardiac output.
A nurse is caring for a patient diagnosed with a mitral valve prolapse who is asymptomatic. The nurse would expect which of the following to be ordered for this patient? No treatment required Beta blockers Calcium channel blockers Heparin
No treatment required Explanation: No treatment is required for asymptomatic patients. If symptoms develop, management is aimed at symptomatic control. Beta blockers and calcium channel blockers may be used to relieve chest pain and palpitations. Heparin would not be ordered for this patient.
Which of the following is a late clinical manifestation of mitral stenosis? Peripheral edema Dyspnea on exertion (DOE) Progressive fatigue Atrial fibrillation
Peripheral edema Explanation: Late symptoms of right heart failure include peripheral edema and ascites. Symptoms of dyspnea on exertion, progressive fatigue as a result of low cardiac output, and atrial fibrillation occur in mitral stenosis.
Hattie Willoughby, a 62-year-old female, is two weeks CABG and is returning to her cardiologist due to new symptoms. She reports heaviness in her chest, and pain between her breasts. She reports that leaning forward decreases the pain. After his thorough examination, the cardiologist admits her to the hospital to rule out pericarditis. Which of the following is not a contributing cause to pericarditis? Pneumonia Tuberculosis MI Chest trauma
Pneumonia Explanation: Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or myocardial infarction (MI; heart attack) or develops after cardiac surgery.
Which of the following is an action of the intra-aortic balloon pump (IABP)? Reduction of left ventricular afterload Reduction of right ventricular afterload Reduction of left ventricular preload Reduction of right ventricular preload
Reduction of left ventricular afterload Explanation: The IABP decreases the workload of the heart by reducing left ventricular afterload. Additionally, it improves coronary artery blood flow by increasing coronary artery perfusion pressure. It does not reduce left or right ventricular preload.
What is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Degenerative stenosis Myocardial infarction
Rheumatic endocarditis Explanation: Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. In adults, aortic stenosis is often a result of degenerative calcifications. Congestive heart failure and myocardial infarction are not the most common cause of mitral stenosis. Reference:
Which of the following is the most significant risk factor for mitral stenosis? Rheumatic fever Infective endocarditis Marfan's syndrome Dissecting aortic aneurysm
Rheumatic fever Explanation: The most significant risk factor for mitral stenosis is rheumatic fever, which gradually causes the mitral valve leaflets to thicken and can result in leaflet fusion. Risk factors for aortic regurgitation are infective endocarditis, Marfan's syndrome, and a dissecting aortic aneurysm.
Which of the following are the first symptoms of cardiac tamponade? Select all that apply. Shortness of breath Chest tightness Dizziness Tachycardia Neck vein distention
Shortness of breath Chest tightness Dizziness Explanation: The first symptoms of cardiac tamponade are often shortness of breath, chest tightness, dizziness, or restlessness. The patient may have tachycardia. Neck vein distention and other signs of rising central venous pressure develop.
A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client? The high risk for complications if she becomes pregnant while taking warfarin Instructions for using the rhythm method Symptoms to report of worsening tachycardia related to atrial fibrillation Foods to limit (green leafy vegetables) while taking warfarin
The high risk for complications if she becomes pregnant while taking warfarin Explanation: Women of childbearing age should not take warfarin (pregnancy X category) if they plan to become pregnant. There is danger to the placenta and risk for the mother to bleed. The fetus may also be affected. This client should practice a more reliable method of birth control.
Which of the following is the most common complication of prosthetic valves? Thromboembolism Hemolysis Infection Arrhythmias
Thromboembolism Explanation: Thromboembolism is the most common complication of prosthetic valves and long-term anticoagulation with warfarin is initiated 48 hours after surgery. Overall, patients are at risk for thromboembolism, infection, arrhythmias, and hemolysis.
Myocarditis is most commonly caused by which of the following? Viral infection Bacterial infection Immune-mediated mechanisms Toxic agents
Viral infection Explanation: Myocarditis is an inflammation of the heart muscle, commonly resulting from viral infection. It may also be caused by bacterial infections, immune-mediated mechanisms, and toxic agents.
Which of the following clinical manifestations would the nurse expect to find in the patient diagnosed with aortic regurgitation? Visible neck vein pulsations Pulse pressure shortens Systolic pressure is lower in the lower extremities Decrescendo systolic murmur
Visible neck vein pulsations Explanation: Palpations, particularly when lying down, and visible neck vein pulsations are a result of the increased force and volume of blood ejected from the hypertrophied left ventricle. Pulse pressure widens. Systolic blood pressure in the lower extremities is higher than in the upper extremities. A decrescendo diastolic murmur is heard as a high-pitched blowing sound at the third or fourth intercostals space at the left sternal border.
The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? Warfarin Aspirin Furosemide Digoxin
Warfarin Explanation: To reduce the risk of thrombosis in patients with porcine or bovine tissue valves, warfarin is required for 6 to 12 weeks, followed by aspirin therapy. Furosemide would not be given for 6 to 12 weeks following this type of surgery. Digoxin may be used for the treatment of arrhythmias, but not just for 6 to 12 weeks.
Which type of graft is utilized when a heart valve replacement is made of tissue from an animal heart valve? Autograft Allograft Homograft Xenograft
Xenograft Explanation: Xenograft refers to replacement of tissue from animal tissue. An autograft is a heart valve replacement made from the patient's own heart valve. Allograft refers to replacement using human tissue and is a synonym for homograft. Homograft refers to replacement using human tissue and is a synonym for allograft.
A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to: call the physician to request an increase in the warfarin dose. give the client an I.M. vitamin K injection and notify the physician of the results. assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. notify the next shift to hold the daily 5 p.m. dose of warfarin.
assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. Explanation: For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the physician of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a physician's order. The nurse should notify the physician before holding a medication scheduled to be administered during another shift.
A nurse is assessing a client with aortic stenosis. The nurse expects to hear a murmur that is: high-pitched and blowing. loud and rough during systole. low-pitched, rumbling during diastole. low-pitched and blowing.
loud and rough during systole. Explanation: An aortic murmur is loud and rough and is heard over the aortic area. The murmur in aortic insufficiency is high-pitched and blowing and is heard at the third or fourth intercostal space at the left sternal border. Mitral stenosis has a low-pitched rumbling murmur heard at the apex. Mitral insufficiency has a high-pitched, blowing murmur at the apex. There is no condition that has a low-pitched, blowing murmur.
