Valvular Disease

The nurse should teach the client who is receiving warfarin sodium that: A. partial thromboplastin time values determine the dosage of warfarin sodium B. protamine sulfate is used to reverse the effects of warfarin sodium C. international normalized ratio (INR) is used to assess effectiveness D. warfarin sodium will facilitate clotting of the blood

C

Which is the most important initial post-procedure nursing assessment for a client who has had a cardiac catheterization A. Monitor lab values B. Observe neurologic function Q15 minutes C. Observe the puncture site for swelling and bleeding D. Monitor the skin warmth and turgor

C

A client has mitral valve 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

A

The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to: A. Observe careful handwashing procedures B. Clean the incisional area with an antiseptic C. Use prepackaged sterile dressings to cover the incision D. Place soiled dressings in a waterproof bag before disposing of them

A

Three 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 post-operative course

A

Which measure should the nurse institute to help prevent complications associated with excessive calcium excretion following cardiac surgery to replace an aortic valve? A. Ensure a liberal fluid intake B. Provide an alkaline-ash diet C. Prevent constipation D. Enrich the client's diet with dairy products

A

A nurse educator is reviewing expected findings in a client who has right-sided valvular heart disease with a group of nurses. Which of the following findings should the nurse include in the discussion? SELECT ALL THAT APPLY A. dyspnea B. client report of fatigue C. bradycardia D. pleural friction rub E. peripheral edema

A,B,E

A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? SELECT ALL THAT APPLY A. Surgical repair of an atrial septal defect at age 2 B. Measles infection during childhood C. Hypertension for 5 years D. Weight gain of 10 lbs in past year E. Diastolic murmur present

A,C,E

Good dental care is an important measure 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 the use of electric toothbrush c. take an antibiotic prior to oral surgery d. floss the teeth at least once a day e. have regular dental checkup f. rinse the mouth with an antibiotic mouthwash once a day

A,D,E

A client experiences initial indications of dizziness after having an IV infusion of lidocaine hydrochloride started. The nurse should further assess the client when the client reports having: A. palpitations B. tinnitus C. urinary frequency D. lethargy

B

A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statement by the client indicates 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"

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

B

An older adult client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the healthcare provider has written a prescription to: A. limit the amount of protein in the diet prior to the cardiac catheterization B. withhold the metformin prior to the cardiac catheterization C. administer the metformin with only a sip of water prior to the cardiac catheterization D. give the metformin before breaskfast

B

Before a client's discharge after mitral valve replacement surgery, the nurse should evaluate the client's understanding of post-surgery 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 10lb C. a program of gradually progressive walking D. light housework

B

A client is scheduled for a cardiac catheterization. The nurse should do which preprocedure tasks? SELECT ALL THAT APPLY A. Administer all prescribed oral medications B. Check for iodine sensitivity C. Verify that written consent has been obtained D. Withhold food and oral fluids before the procedure E. Insert a urinary drainage catheter

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 post-operative 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 <100mmHg

B,C,D

A nurse is caring for a 72 year old client who is to undergo a percutaneous balloon valvuloplasty. The client's daughter 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 in your mother's coronary arteries." B. "This will permit your mother to resume her ADLs" C. "This will prolong your mother's life" D. "This will reverse the effects to the damaged area."

B: surgery is indicated for older adults when manifestations interfere with ADLs

A client has returned from the cardiac catheterization lab after a balloon valvuloplasty for mitral stenosis. Which finding requires immediate nursing action? A. There is a low, grade 1 intensity mitral regurgitation murmur. B. SpO2 is 94% on 2L nasal cannula C. Client has become more somnolent(drowsy) D. Urine output decreased from 60ml/hr to 40 ml over the last hour.

C

A nurse is completing the admission physical assessment of a client who has a history of 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

C

In preparing the client and the family for a postoperative stay in the ICU after open-heart surgery, the nurse should explain that: A. the client will remain in the ICU for 5 days B. the client will sleep most of the time while in the ICU C. noise and activity within the ICU are minimal D. the client will receive medication to relieve pain

D