Exam 1: Valvular Heart Diseases
Biologic
Interprofessional Care: Valvular Heart Disease ___________ valves do not require anticoagulation therapy because of their low thrombogenicity. However, they are less durable and tend to cause early calcification, tissue degeneration, and stiffening of the leaflets
a
3 days after mitral valve replacement surgery, the client tells the nurse there is a "clicking" noise coming from the chest incision. The nurse's response should reflect the understanding that the client may be experiencing a. anxiety related to altered body image b. depression related to altered health status c. altered tissue perfusion d. lack of knowledge regarding the postoperative course
a
While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate intervention by the nurse is to a. promote rest to decrease myocardial oxygen demand. b. educate the patient about the need for anticoagulant therapy. c. teach the patient to use sublingual nitroglycerin for chest pain. d. elevate the head of the bed 60 degrees to decrease venous return.
d
While caring for a patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to a. plan to take antibiotics before any dental appointments. b. limit physical activity to avoid stressing the heart valves. c. take 1 aspirin a day to prevent embolization from the valve. d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.
c
A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which information will the nurse include? a. Biologic replacement valves require the use of immunosuppressive drugs. b. Mechanical mitral valves require replacement approximately every 5 years. c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.
c
A 72-yr-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? a. Aspirin b. Oxygen c. Nitroglycerin d. Morphine sulfate
a
A client has mitral stenosis and will have a valve replacement. The nurse is instructing the client about health maintenance prior to surgery. Inability to follow which prescription would pose the greatest health hazard to this client at this time? a. medication therapy b. diet modification c. activity restrictions d. dental care
c
A client has returned from the cardiac cath lab after a balloon valvuloplasty for mitral stenosis. Which finding required immediate nursing action? a. there is a low, grade 1 intensity mitral regurgitation murmur b. SpO2 is 94% on 2L of oxygen via nasal cannula c. client has become more somnolent d. urine output decreased from 60 ml/h to 40 ml over the past hour
b c d
A client who has undergone a mitral valve replacement has had a mediastinal chest tube inserted. The client has persistent bleeding from the sternal incision during the early postoperative period. What actions should the nurse take? Select all that apply a. administer warfarin b. check the postoperative CBC, INR, PTT, and platelet levels c. confirm availability of blood products d. monitor the mediastinal chest tube drainage e. start a dopamine drip for a systolic BP <100
b
A nurse is caring for an older adult client who is to undergo a percutaneous balloon valvuloplasty. The client's family member asks the nurse to explain the expected outcome of this procedure. Which of the following responses should the nurse give? a. "this will improve blood flow to the coronary arteries" b. "this will assist with the ability to perform activities of daily living" c. "this will prolong the lifespan of living with this valve disorder" d. "this will reverse the effects to the damaged area"
b
A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statements by the client indicates an understanding of the teaching? a. "I will be glad to get back to my exercise routine right away" b. "I will have my prothrombin time checked on a regular basis" c. "I will talk to my dentist about no longer needing antibiotics before dental exams" d. "I will continue to limit my intake of foods containing potassium"
c
A nurse is completing the admission physical assessment of a client who has mitral valve insufficiency. Which of the following findings should the nurse expect? a. S4 heart sound b. petechiae c. crackles in lung bases d. splenomegaly
a
A patient has been diagnosed with chronic mitral regurgitation. When interviewing the patient, which of these should the healthcare provider expect the patient to report? a. Frequent dyspnea b. Occasional syncope c. Swelling of the feet d. Insomnia 3 nights/week
a c d
A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to the unlicensed assistive peronnel? Select all that apply a. obtain and record daily weight b. determine apical-radial pulse rate c. observe for overt signs of bleeding d. obtain and record vital signs, including pulse oximetry e. teach the patient how to purchase a Medic Alert device
c
A patient is scheduled for an open surgical valvuloplasty of the mitral valve. In preparing the patient for surgery, what should the nurse know about this surgery? a. cardiopulmonary bypass is not required with this procedure b. valve repair is a palliative measure, whereas valve replacement is curative c. the operative mortality rate is lower in valve repair than in valve replacement d. patients with valve repair do not require postoperative anticoagulation as do those who have valve replacement
a
A patient who has a diagnosis of mitral valve stenosis is admitted to the hospital. Which of these findings indicate the patient is experiencing a serious complication from this valve disorder? a. Left hemiparesis and visual changes b. Hypotension and syncope c. Intermittent claudication d. Sudden onset of dyspnea
c
A patient with a history of coronary artery disease is being treated for a myocardial infarction (MI). During treatment, acute mitral valve regurgitation occurs. What is the most likely cause of the acute mitral valve dysfunction? a. Ventricular fibrillation b. Infective endocarditis c. Rupture of the chordae tendinae d. Atherosclerosis
b
A patient with symptomatic mitral valve prolapse has atrial and ventricular dysrhythmias. In addition to monitoring for decreased cardiac output related to the dysrhythmias, what is an important nursing intervention related to the dysrhythmias identified by the nurse? a. monitor breathing pattern related to hypervolemia b. encourage calling for assistance when getting out of bed c. give sleeping pills to decrease paroxysmal nocturnal dyspnea d. teach the patient exercises to prevent recurrence of dysrhythmias
b
A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nurse administers furosemide to treat pulmonary congestion and begins a nitroprusside drip as prescribed. The nurse notices a sudden drop in the pulmonary artery diastolic pressure and pulmonary artery wedge pressure. The nurse should first assess a. 12 lead EKG b. blood pressure c. lung sounds d. urine output
Tricuspid
____________ valve stenosis causes right atrial enlargement and increased systemic venous pressure. This results in peripheral edema, ascites, hepatomegaly, and a murmur
d
An 80-yr-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? a. Aortic valve replacement b. Take nitroglycerin for chest pain. c. Open commissurotomy (valvulotomy) procedure d. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure
Pulmonic
____________ valve stenosis causes right ventricular hypertension and hypertrophy. This results in fatigue, as well as a loud murmur
Volume
Aortic Valve Regurgitation Aortic regurgitation causes retrograde blood flow from the ascending aorta into the left ventricle during diastole. This results in ________ overload.
Water-Hammer
Aortic Valve Regurgitation Patients with aortic valve regurgitation develop a ________-_________ pulse, which is a strong, quick beat that collapses immediately
Pulmonary Right
Aortic Valve Regurgitation The left ventricle initially compensates for chronic aortic regurgitation by dilation and hypertrophy. Myocardial contractility eventually declines, and blood volume in the left atrium and pulmonary bed increases, leading to ______________ hypertension and ______ ventricular failure
Hypertrophy
Aortic Valve Stenosis Aortic stenosis causes obstruction of blood flow from the left ventricle to the aorta during systole. The effect is left ventricular __________ and increased myocardial oxygen consumption because of the increased myocardial mass
Compensatory
Aortic Valve Stenosis As the disease progresses and ___________ mechanisms fail, reduced cardiac output leads to decreased tissue perfusion, pulmonary hypertension, and heart failure
Calcification
Aortic Valve Stenosis In aortic valve stenosis, fusion of the commissures and secondary _____________ causes the leaflets to stiffen and retract, resulting in stenosis
1/3
Aortic Valve Stenosis Manifestations of aortic stenosis occur when the valve orifice becomes _______ its normal size. These manifestations include angina, syncope, and exertional dyspnea, reflecting left ventricular failure
Nitroglycerin
Aortic Valve Stenosis When treating aortic valve stenosis, it is important to use ___________ cautiously, as it reduces preload and BP, which can worsen chest pain
b
Before a client's discharge after mitral valve replacement surgery, the nurse should evaluate the client's understanding of postsurgery activity restrictions. The client should avoid which activity until after the 1 month postdischarge appointment with the surgeon? a. showering b. lifting anything heavier than 10 lb c. a program of gradually progressive walking d. light housework
Valvuloplasty
Interprofessional Care: Valvular Heart Disease Open surgical ________ involves repair of a valve by suturing the torn leaflets, chordae tendinae, or papillary muscles. It is primarily used to treat mitral or tricuspid regurgitation
Transcatheter Aortic Valve Replacement (TAVR)
Interprofessional Care: Valvular Heart Disease This is a procedure in which the existing aortic valve is left in place and a fully collapsible replacement valve is delivered to the valve site through a catheter
Valvuloplasty
Interprofessional Care: Valvular Heart Disease This procedure is called a percutaneous transluminal balloon _____________. During the procedure, the fused commissures are split open. A balloon-tipped catheter is threaded to the stenotic valve and inflated in an attempt to separate the valve leaflets
Mechanical
Interprofessional Care: Valvular Heart Disease ___________ valves are more durable and last longer, however they have an increased risk of thromboembolism and require long-term anticoagulation therapy
c
During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding the a. use of daily aspirin for anticoagulation. b. correct method for taking the radial pulse. c. need for frequent laboratory blood testing. d. possibility of valve replacement in 7 to 10 years.
a d e
Good dental care is important in reducing the risk of endocarditis. What should a teaching plan to promote good dental care in a client with mitral stenosis instruct the client to do? Select all that apply a. brush the teeth at least twice a day b. avoid use of an electric toothbrush c. take an antibiotic prior to oral surgery d. floss the teeth at least once a day e. have regular dental checkups f. rinse the mouth with an antibiotic mouthwash once a day
c
In which patient would a mechanical prosthetic valve be preferred over a biologic valve for valve replacement? a. 41 year old man with peptic ulcer disease b. 22 year old woman who desires to have children c. 35 year old man with a history of seasonal asthma d. 62 year old woman with early Alzheimer's disease
Commissurotomy
Interprofessional Care: Valvular Heart Disease Mitral _______________ is the procedure of choice for patients with pure mitral stenosis. In this procedure, the fused chordae are separated by splitting the papillary muscle and debriding the calcified valve
Murmur
Mitral Valve Prolapse A characteristic of mitral valve prolapse is a _________ from regurgitation that is louder during systole
Antianginal
Mitral Valve Prolapse Dyspnea, palpitations, and syncope may occasionally accompany the chest pain and do not respond to _______________ treatment
Chest
Mitral Valve Prolapse If _______ pain occurs, episodes tend to occur in clusters, especially during times of emotional stress
Leaflets
Mitral Valve Prolapse Mitral valve prolapse is an abnormality of the mitral valve __________ and papillary muscles or chordae that allows the leaflets to prolapse, or buckle, back into the left atrium during systole
Atrial Hypertrophy
Mitral Valve Regurgitation Chronic clinical manifestations of mitral valve regurgitation include left ______ enlargement and ventricular __________. This eventually leads to a decrease in cardiac output
Pulmonary
Mitral Valve Regurgitation In acute mitral regurgitation, the sudden increase in pressure and volume transmits to the _________ bed. This results in ______________ edema and, if not treated, cardiogenic shock
Third
Mitral Valve Regurgitation Increased left ventricular volume leads to an audible _______ heart sound, even with normal left ventricular function
Closure
Mitral Valve Regurgitation Mitral regurgitation allows blood to flow backward from the left ventricle to the left atrium because of incomplete valve _________ during systole
Thready
Mitral Valve Regurgitation Patients with acute mitral regurgitation have _________ peripheral pulses and cool, clammy extremities
Early
Mitral Valve Regurgitation _________ symptoms of left ventricular failure in mitral regurgitation may include weakness, fatigue, palpitations, and dyspnea
Atrial Fibrillation
Mitral Valve Stenosis Additional symptoms of mitral valve stenosis include murmur, fatigue, palpitations, hoarseness, and which dysrhythmia?
Fish
Mitral Valve Stenosis Contractures and adhesions develop between the commissures, and the stenotic mitral valve takes on a ______ mouth shape because of the thickening and shortening of the mitral valve structures
Pressure Volume
Mitral Valve Stenosis The deformities associated with mitral valve stenosis block the blood flow and create a pressure difference between the left atrium and ventricle during diastole. As a result, left atrial __________ and ________ increase, causing higher pulmonary vasculature pressure
Dyspnea
Mitral Valve Stenosis The primary symptom of mitral stenosis is exertional ____________ caused by reduced lung compliance
Emboli
Mitral Valve Stenosis _________ can form in the left atrium secondary to atrial fibrillation and cause a stroke
c
The healthcare provider is caring for a patient with a systolic heart murmur. Which of these valve disorders are associated with a systolic murmur? a. Aortic and tricuspid stenosis b. Pulmonic regurgitation and tricuspid stenosis c. Aortic stenosis and mitral regurgitation d. Pulmonic and mitral regurgitation
c
The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for the patient who a. was admitted with a large acute myocardial infarction. b. is being discharged after an exacerbation of heart failure. c. has had a mitral valve replacement with a mechanical valve. d. has been treated for rheumatic fever after a streptococcal infection.
b
The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? a. Long-term anticoagulation therapy b. Antibiotic prophylaxis for dental care c. Exercise plan to increase cardiac tolerance d. Take β-adrenergic blockers to control palpitations.
b
The patient is admitted with angina, syncope, and dyspnea on exertion. In the assessment, the nurse notes a systolic murmur with a prominent S4. What will the nurse suspect is occurring with this patient? a. mitral valve stenosis b. aortic valve stenosis c. acute mitral valve regurgitation d. chronic mitral valve regurgitation
Regurgitation
Valvular Heart Disease Type of valvular disorder: -Incomplete closure of valve leaflets -Results in backward flow of blood
Stenosis
Valvular Heart Disease Type of valvular disorder: -Valve orifice is smaller -Forward blood flow is impeded -Pressure differences reflect degree of stenosis -Will present with symptoms similar to left sided HF
c
What accurately describes mitral valve prolapse? a. rapid onset prevents left chamber dilation b. may be caused by pulmonary hypertension c. buckling of valve into left atrium during ventricular systole d. rapid development of pulmonary edema and cardiogenic shock
d
What causes a sudden onset of cardiovascular collapse? a. mitral valve stenosis b. tricuspid valve disease c. pulmonic valve stenosis d. acute aortic regurgitation
d
What is an effect of valvular regurgitation? a. it causes a pressure gradient difference across an open valve b. a pericardial friction rub is heard on the right sternal border of the chest c. it leads to decreased flow of blood and hypertrophy of the preceding chamber d. there is a backward flow of blood and volume overload in the preceding chamber
d
When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. right upper quadrant tenderness. d. complaints of shortness of breath.
d
When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patient says which statement? a. "I may begin an exercise program to gradually increase my cardiac tolerance" b. "I will always need to have my blood checked once a month for its clotting function" c. "I should take prophylactic antibiotics before I have dental or invasive medical procedures" d. "The biggest risk I have during invasive health procedures is bleeding because of my anticoagulants"
a
Which assessment information obtained by the nurse for a patient with aortic stenosis would be most important to report to the health care provider? a. The patient complains of chest pain associated with ambulation. b. A loud systolic murmur is audible along the right sternal border. c. A thrill is palpable at the 2nd intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.
d
Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation? a. reduction in peripheral edema and weight b. carotid venous distention and new-onset atrial fibrillation c. significant pulus paradoxus and diminished peripheral pulses d. shortness of breath on minimal exertion and a diastolic murmur
b
Which drugs would the nurse expect to be included in those prescribed for patients with a mechanical valve replacement? a. oral nitrates b. anticoagulants c. atrial antidysrhythmics d. B-adrenergic blocking agents
a
Which finding in a client with aortic stenosis will be most important for the nurse to report to the health care provider? a. Temperature of 102.1°F (38.9°C) b. Loud systolic murmur over sternum c. Blood pressure of 110/88 mm Hg d. Weak radial and pedal pulses to palpation
b
Which information obtained by the nurse when assessing a patient admitted with mitral valve regurgitation should be communicated to the health care provider immediately? a. The patient has 4+ peripheral edema in both legs. b. The patient has crackles audible to the lung apices. c. The patient has a palpable thrill felt over the left anterior chest. d. The patient has a loud systolic murmur all across the precordium.
