Practice Questions: Valvular Heart Diseases

The nurse will plan discharge teaching about prophylactic antibiotics before dental procedures for which patient? Patient being discharged after an exacerbation of heart failure Patient admitted with a large acute myocardial infarction Patient being treated for rheumatic fever after a streptococcal infection Patient who had a mitral valve replacement with a mechanical valve

Patient who had a mitral valve replacement with a mechanical valve Current American Heart Association guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE.

A nurse cares for a patient recovering from prosthetic valve replacement surgery. The patient asks, "Why will I need to take anticoagulants for the rest of my life?" What is the best response by the nurse? "Blood clots form more easily in artificial replacement valves." "The prosthetic valve places you at greater risk for a heart attack." "The vein taken from your leg reduces circulation in the leg." "The surgery left a lot of small clots in your heart and lungs."

"Blood clots form more easily in artificial replacement valves." Synthetic valve prostheses and scar tissue provide surfaces on which platelets can aggregate easily and initiate the formation of blood clots. The other responses are inaccurate.DIF: Cognitive Level: ApplyingKEY: Valve disorder | patient education | anticoagulantsMSC: Integrated Process: Teaching and Learning NOT: Patient Needs Category: Physiological Integrity: Reduction of Risk Potential

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history focuses on a pertinent risk factor for rheumatic fever? "Do you use any illegal IV drugs?" "Do you have a family history of congenital heart disease?" "Have you had a recent sore throat?" "Have you injured your chest in the last few weeks?"

"Have you had a recent sore throat?" Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever, and it would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.

The nurse obtains a health history from an older patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most focused on identifying a risk factor for IE? "Have you had dental work done recently?" "Have you had any recent immunizations?" "Do you have a history of a heart attack?" "Is there a family history of endocarditis?"

"Have you had dental work done recently?" Dental procedures place the patient with a prosthetic mitral valve at risk for IE. Myocardial infarction, immunizations, and a family history of endocarditis are not risk factors for IE.

The home health nurse is visiting a 30-yr-old patient recovering from rheumatic fever without carditis. The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when the patient makes which statement? "I will be immune to future episodes of rheumatic fever after this infection." "I can take aspirin or ibuprofen (Motrin) to relieve my joint pain." "I should call the health care provider if I am fatigued or have difficulty breathing." "I will need prophylactic antibiotic therapy for 5 years."

"I will be immune to future episodes of rheumatic fever after this infection." Patients with a history of rheumatic fever are more susceptible to a second episode. Patients with rheumatic fever without carditis require prophylaxis until age 20 years and for a minimum of 5 years. The other patient statements are correct and would not support the nursing diagnosis of ineffective health maintenance.

After teaching a patient who is being discharged home after mitral valve replacement surgery, the nurse assesses the patient's understanding. Which patient statement indicates a need for additional teaching? "I'll be able to carry heavy loads after 6 months of rest." "I will have my teeth cleaned by my dentist in 2 weeks." "I must use an electric razor instead of a straight razor to shave." "I must avoid eating foods high in vitamin K, like spinach."

"I will have my teeth cleaned by my dentist in 2 weeks." Patients who have defective or repaired valves are at high risk for endocarditis. The patient who has had valve surgery should avoid dental procedures for 6 months because of the risk for endocarditis. When undergoing a mitral valve replacement surgery, the patient needs to be placed on anticoagulant therapy to prevent vegetation forming on the new valve. Patients on anticoagulant therapy would be instructed on bleeding precautions, including using an electric razor. If the patient is prescribed warfarin, the patient should avoid foods high in vitamin K. Patients recovering from open heart valve replacements should not carry anything heavy for 6 months while the chest incision and muscle heal.DIF: Cognitive Level: ApplyingKEY: Valve disorder | patient education | hygieneMSC: Integrated Process: Teaching and Learning NOT: Patient Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse assesses a patient who has mitral valve regurgitation. For which cardiac dysrhythmia would the nurse assess? Atrial fibrillation Sinus tachycardia Preventricular contractions Symptomatic bradycardia

Atrial fibrillation Atrial fibrillation is a clinical manifestation of mitral valve regurgitation and stenosis. Preventricular contractions and bradycardia are not associated with valvular problems. These are usually identified in patients with electrolyte imbalances, myocardial infarction, and sinus node problems. Sinus tachycardia is a manifestation of aortic regurgitation due to a decrease in cardiac output.DIF: Cognitive Level: UnderstandingKEY: Valve disorder | cardiac dysrhythmiaMSC: Integrated Process: Nursing Process/Assessment NOT: Patient Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse assesses a patient with mitral valve stenosis. What clinical manifestation would alert the nurse to the possibility that the patient's stenosis has progressed? Muted systolic murmur Upper extremity weakness Oxygen saturation of 92% Dyspnea on exertion

Dyspnea on exertion Dyspnea on exertion develops as the mitral valvular orifice narrows and pressure in the lungs increases. The other manifestations do not relate to the progression of mitral valve stenosis.DIF: Cognitive Level: ApplyingKEY: Valve disorder | respiratory distress/failureMSC: Integrated Process: Nursing Process/Assessment NOT: Patient Needs Category: Physiological Integrity: Reduction of Risk Potential

A 21-yr-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? Mechanical mitral valves need to be replaced sooner than biologic valves. Lifelong anticoagulant therapy is needed after mechanical valve replacement. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty. Biologic valves will require immunosuppressive drugs after surgery.

Lifelong anticoagulant therapy is needed after mechanical valve replacement. Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system and immunosuppressive therapy is not needed.

After receiving information about four patients during change-of-shift report, which patient should the nurse assess first? Patient with a mitral valve replacement who has an anticoagulant scheduled Patient with acute pericarditis who has a pericardial friction rub Patient who has hypertrophic cardiomyopathy and a heart rate of 116 Patient who has just returned to the unit after balloon valvuloplasty

Patient who has just returned to the unit after balloon valvuloplasty The patient who has just arrived after balloon valvuloplasty will need assessment for complications such as bleeding and hypotension. The information about the other patients is consistent with their diagnoses and does not indicate any complications or need for urgent assessment or intervention.

When developing a community health program to decrease the incidence of rheumatic fever, which action should the community health nurse include? Teach community members to seek treatment for streptococcal pharyngitis. Teach about prophylactic antibiotics to those with a family history of rheumatic fever. Teach about the importance of monitoring temperature when sore throats occur. Vaccinate high-risk groups in the community with streptococcal vaccine.

Teach community members to seek treatment for streptococcal pharyngitis. The incidence of rheumatic fever is decreased by treatment of streptococcal infections with antibiotics. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Teaching about monitoring temperature will not decrease the incidence of rheumatic fever.

The nurse is caring for a patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider? The point of maximum impulse (PMI) is at the left midclavicular line. A loud systolic murmur is heard along the right sternal border. The patient complains of chest pressure when ambulating. A thrill is palpated at the second intercostal space, right sternal border.

The patient complains of chest pressure when ambulating. Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal.

The nurse is caring for a 64-yr-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? The patient has diffuse bilateral crackles. The patient has a loud systolic murmur across the precordium. The patient has a palpable thrill felt over the left anterior chest. The patient has 4+ peripheral edema.

The patient has diffuse bilateral crackles. Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)? Increase in heart rate of 15 beats/minute with walking Urine output less than 30 mL/hr Petechiae on the inside of the mouth and conjunctiva Fever, chills, and diaphoresis

Urine output less than 30 mL/hr Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output. Petechiae, fever, chills, and diaphoresis are symptoms of IE but are not caused by decreased cardiac output. An increase in pulse rate of 15 beats/min is normal with exercise.

During the assessment of a young adult patient with infective endocarditis (IE), the nurse would expect to find: substernal chest pressure. a new regurgitant murmur. involuntary muscle movement. a pruritic rash on the chest.

a new regurgitant murmur. New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.

While caring for a 23-yr-old 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: avoid over-the-counter (OTC) drugs that contain stimulants. take an aspirin a day to prevent clots from forming on the valve. take antibiotics before any dental appointments. limit physical activity to avoid stressing the heart.

avoid over-the-counter (OTC) drugs that contain stimulants. Use of stimulant drugs should be avoided by patients with MVP because they may exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.

During discharge teaching with an older patient who had a mitral valve replacement with a mechanical valve, the nurse must instruct the patient on the: need for frequent laboratory blood testing. use of daily aspirin for anticoagulation. need to avoid any physical activity for 1 month. correct method for taking the radial pulse.

need for frequent laboratory blood testing. Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate nursing intervention for this patient would be to: teach the patient about the need for anticoagulant therapy. promote rest to decrease myocardial oxygen demand. teach the patient to use sublingual nitroglycerin for chest pain. raise the head of the bed 60 degrees to decrease venous return.

promote rest to decrease myocardial oxygen demand. Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for the development of: shortness of breath. mental status changes. splenomegaly. flank pain.

shortness of breath Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain, changes in mental status, and splenomegaly would be associated with embolization from the left-sided valves.

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for: right upper quadrant tenderness. shortness of breath on exertion. peripheral edema. diastolic murmur.

shortness of breath on exertion. The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia, which is a priority.