Chapter 24: Caring for Clients with Valvular Disorders of the Heart

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 Shoulder pain Hyperpnea Palpitations

Chest pain Fatigue Palpitations

A client has been prescribed a Class III Antiarrhythmic (potassium channel blocker). The nurse will educate the client that which specific food item may not be eaten (or drank) while on this medication? Red meat Dairy products Tyramine-containing foods Citrus juice, especially grapefruit

Citrus juice, especially grapefruit

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. reassuring that the client "won't feel a thing" because of the anesthesia. reminding the client that surgical team is highly skilled. encouraging the client to consider drug therapy instead.

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

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 2 3 4

1

The nurse is monitoring the prothrombin time (PT) of a client taking anticoagulant therapy. Which of the following values would the nurse consider normal? 1.5 2.5 3.5 4.5

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? 1 2 3 4

3

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 Mitral Tricuspid Pulmonic Thoracic

Aortic Mitral Tricuspid Pulmonic

Which of the following procedures describes splitting or separating fused cardiac valve leaflets? Annuloplasty Chordoplasty Valvuloplasty Commissurotomy

Commissurotomy

In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased: stroke volume. left ventricular size. coronary perfusion. arterial pulse pressure.

Coronary perfusion

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? Fill in the blank with a number

1

The nurse is weighing the client with a valvular disorder daily at the same time, with similar clothing, on the same scale. In 24 hours, the client shows a weight gain of 4 lbs. How much fluid would the nurse estimate that the client is retaining? Fill in the blank with a number.

2

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? 3 4 5 6

6

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? Ice cream Dehydrated apple chips Bread Canned soup

Canned soup

The nurse is caring for a client with aortic regurgitation for which the health care provider has prescribed a beta-blocker. The nurse should know that a client with which other disorder will require frequent assessments due to this medication? Peripheral neuropathy Frequent upper respiratory infections Diabetes mellitus Multiple sclerosis

Diabetes mellitus

What instruction should be included in the teaching plan for a client with aortic stenosis? Eliminate smoked or processed meats. Use condiments to enhance flavor. Use a salt substitute. Increase intake of calcium products like milk and ice cream.

Eliminate smoked or processed meats.

Clients with valvular disorders who are taking prescribed anticoagulants should be instructed about which possible side effects? increased bleeding time anaphylaxis superinfection hallucinations

Increased bleeding time

The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what? Cardiac tamponade Left ventricular enlargement Right-sided heart failure Ventricular insufficiency

Left ventricle enlargement

Which of the following dietary recommendations should a nurse give a patient with mitral valve prolapse to compensate for symptoms associated with hypovolemia? Avoidance of coffee Liberal fluid intake High-fiber diet Low-calorie diet

Liberal fluid intake

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 Aortic Bicuspid Pulmonic

Mitral

A 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 mitral regurgitation aortic stenosis aortic regurgitation

Mitral stenosis

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. aortic regurgitation. aortic stenosis. mitral regurgitation.

Mitral stenosis

A client with mitral insufficiency is being treated with quinidine to control tachycardia. When assessing the client, the nurse should observe for signs of: toxicity. anemia. thrombocytosis. infection.

Toxicity

In addition to age, what else is a risk factor for aortic stenosis? history of infective endocarditis history of syphilis myocardial infarction mitral valve prolapse

history of infective endocarditis

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? Patient controlled analgesia Long-term anticoagulant therapy Long-term steroid therapy Exercise program

long-term anticoagulant therapy

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? 2 3 4 5

4

The nurse is caring for an older adult client who previously had a balloon valvuloplasty for treatment of aortic stenosis. In the last 6 months, the client's symptoms have returned and the client has been scheduled for a transcatheter aortic valve implantation. The client is very upset and states, "With all of my other health problems, I'll never survive having my whole chest cut open." What is the nurse's best response to this client? "You will do fine. You have a wonderful surgeon and though it may take a little longer for you to recover, it will eventually happen." "Have you discussed the procedure with your doctor? This type of valve replacement doesn't require an incision in your chest." "You don't have to have the procedure if you don't want to, but your symptoms will just keep getting worse." "Can you tell me more about these other health problems you are concerned about?"

"Have you discussed the procedure with your doctor? This type of valve replacement doesn't require an incision in your chest."

The nurse is interviewing a client who presents to the clinic with symptoms of aortic regurgitation. When taking the client's medical history, the nurse will ask which question that may be related to the cause of the client's present symptoms? "Were you a long-distance runner at any time?" "Did you work in the coal industry in the past?" "Have you previously taken medication to help you lose weight?" "Have you ever lived in a house that required treatment for mold?"

"Have you previously taken medication to help you lose weight?"

The nurse is caring for a client with aortic stenosis who has just been started on medication. The nurse has also given the client information about dietary restrictions related to this condition. Which statement by the client indicates a need for further instruction? "I will make sure that I don't add any salt to my food when I cook and at the table." "I will try to avoid salty snack foods, even though those are some of my favorites." "I plan to eat a lot of soup because it is inexpensive, it stores well on the shelf and I can fix it quickly." "I used to buy a lot of food from the delicatessen but I will try to limit that now."

"I plan to eat a log of soup because it is inexpensive, it stores well on the shelf and I can fix it quickly."

The nurse is completing discharge instructions with a client who has a valvular disorder and has recently developed symptoms related to this disorder. The client states, "I understand why I need to take the heart medicine and the water pills, but I don't understand why I need to take a pill for my bowels". What is the nurse's best response to this client? "Most people who start new medication begin to have loose stools so this medicine will make sure that doesn't happen." "I realize that it doesn't make a lot of sense but this medication will ultimately help you feel better." "This medicine softens your stool because it isn't good for your heart to strain when you have a bowel movement." "You don't need to take the medicine for your bowels very day. Just take it if you have any bowel problems."

"This medicine softens your stool because it isn't good for your heart to strain when you have a bowel movement."

The nurse is caring for a client with symptomatic aortic stenosis. The health care provider has suggested that the client be treated with a balloon valvuloplasty but the client is reluctant to proceed with the procedure. What is the BEST response to the client concerning this issue? "I realize you are worried but having this procedure means you will never have to worry about this problem again." "I understand your reluctance to have an invasive procedure. Why don't you see if your health care provider can increase your current medication doses?" "This must be very frightening to consider but depending on medication alone may result in very serious consequences for you." "It's always hard to face a procedure like this but just go ahead and have it done and get it over with."

"This must be very frightening to consider but depending on medication alone may result in very serious consequences for you."

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

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. Alcohol use can lead to bradycardia and hypotension, which increases risk for falls. Alcohol can deplete levels of potassium, causing hypokalemia. Alcohol can compound pre-existing heart murmurs.

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

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 aortic hypertrophy mitral stenosis mitral regurgitation

Aortic stenosis

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 Mitral stenosis Mitral valve prolapse Aortic regurgitation

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? Normal sinus rhythm Supraventricular tachycardia Atrial fibrillation Electromechanical dissociation

Atrial fibrillation

The nurse talking to a client who has been diagnosed with mitral valve prolapse and shares which lifestyle adjustments could help with symptoms associated with mitral valve prolapse? Select all that apply. Limit fluid intake. Avoid coffee and colas. Drink 2 beers or 1 glass of wine/day. Do not limit salt intake. Do not drink any type of whiskey.

Avoid coffee and colas. Do not limit salt intake. Do not drink any type of whiskey.

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 Obstruction of blood flow from the left ventricle Blood to flow back from the left atrium to the left ventricle Obstruction of blood from the left atrium to left ventricle

Blood to flow back from the aorta to the left ventricle

The home health nurse visits a client who was recently diagnosed with aortic regurgitation. The nurse notes that the client appears unwell and when asked by the nurse if anything has changed since the last visit, the client states, "I was sick to my stomach for a few days and couldn't take the medicine the doctor gave me so I took it all today." With the knowledge that this medication is a beta-blocker, the nurse notifies the health care provider and assesses the client for what signs of an overdose? Select all that apply. Tachycardia Bluish discoloration to the palm Dizziness Drowsiness Irritability

Bluish discoloration to the palm Dizziness Drowsiness

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 elimination of extra, ineffective beats decrease in shortness of breath maintenance of intravascular fluid volume

Changes in blood volume in the heart

The nurse is aware that the following finding is often the earliest indication of mitral stenosis: Changes in heart sounds Hypertension Weight gain Dizziness

Changes in heart sounds

The nurse is assessing an older adult client who has come to the health care practitioner complaining of weakness and fatigue. While the nurse recognizes that these symptoms may be related to age related cardiac valvular disease, the symptoms may also be related to what other more common condition? Pneumonia Dehydration Rhinovirus Bronchitis

Dehydration

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? Palpable arterial pulsations New murmur Difficulty breathing Mitral click

Difficulty breathing

A client with aortic stenosis is at a greater risk for falls because: dizziness and fainting are symptoms. vision will be impaired. coordination will be affected. the client is over age 70 years.

Dizziness and fainting are symptoms

The nurse is caring for a patient who is scheduled for a balloon valvuloplasty. The nurse recalls that balloon valvuloplasty is most commonly used for which valvular heart disease? Aortic regurgitation Mitral valve prolapse Mitral stenosis Mitral regurgitation

Mitral stenosis

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. Urinary output is a reflection of the effectiveness of valvuloplasty procedures. Urine output will show any lingering signs of infection that may have contributed to the valve problem. The client's kidneys will directly affect the pumping of the heart.

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

Diagnostic findings confirm that a client, although asymptomatic, has aortic stenosis. What should the nurse incorporate into the plan of care? Select all that apply. Restrict dietary sodium and caffeine intake. Prepare the client and family for the likelihood of aortic valve replacement in the future. Encourage compliance with prescribed drug treatment. Recommend strenuous regular exercise for weight control.

Restrict dietary sodium and caffeine intake. Prepare the client and family for the likelihood of aortic valve replacement in the future. Encourage compliance with prescribed drug treatment.

A client has mitral regurgitation. Which of the following heart sounds does the nurse recognize as a sign of impending heart failure? S3 S4 Grade 1 murmur Grade 5 murmur

S3

The nurse is assessing a client who recently began experiencing dizziness and weakness. The nurse will note which manifestation on the cardiac assessment which is suggestive of aortic stenosis? Split S2 sound and the PMI is displaced laterally from its usual location Split S1 sound and an inability to locate the PMI on the client's chest S3 and S4 identified with a normal PMI Normal heart sounds and a PMI that is displaced to the right of the sternum

Split S2 sounds and the PMI is displaced laterally from its usual location