Client with valvular heart disease

3 (Assessment of circulatory status, including observing the puncture site, is of primary importance after a cardiac cath. Lab values, skin warmth and turgor are important to monitor but not the most important initial assessment. Neuro assessment q15 min is not required)

Which is the most important initial post-procedure nursing assessment for a client who has had a cardiac catheterization? 1. monitor the lab values 2 observe neuro function every 15 mins 3 observe the puncture site for bleeding and swelling 4. monitor skin warmth and turgor

2 (Common adverse effects of lidocaine hydrochloride include dizziness, tinnitus, blurred vision, tremors, numbness and tingling of extremities, excessive perspiration, hypotension, seizures, and finally coma. Cardiac effects include slowed conduction and cardiac arrest. Palpitations, urinary frequency, and lethargy are not considered typical adverse reactions to lidocaine)

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: 1. palpitations 2, tinnitus 3, urinary frequency 4. lethargy

1 (pre operatively, anticoagulants may be prescribed for the client with advanced valvular heart disease to prevent emboli. Postop, all clients with mechanical valves and some clients with bioprosthesis are maintained indefinitely on anticoagulant therapy Adhering strictly to a dosage schedule and observing specific precautions are necessary to prevent hemorrhage or thromboembolism. Some clients are maintained on lifelong antibiotic prophylaxis to prevent recurrence of rheumatic fever. Episodic prophylaxis is required to prevent inefective endocarditis after dental procedures or upper respiratory, GI or GU tract surgery. Diet modification, activity restrictions, and dental care are important, however they do not have as much significance post op as medication therapy does)

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? 1. medication therapy 2. diet modification 3. activity restriction 4. dental care

3 (A complication of balloon valvuloplasty is emboli resulting in a stroke. The clients increased drowsiness should be evaluated Some degree of mitral regurgitation is common after the procedure. The O2 status and urine output should be monitored closely but do not warrant concern)

A client has returned from the cardiac catheterization lab after a balloon valvuloplasty for mitral stenosis. Which of the following requires immediate nursing action? 1. There is a low grade 1 intensity mitral regurgitation murmur 2 SpO2 is 94% on 2 L of O2 via nasal cannula 3. Client has become more somnolent 4 Urine output decreased from 60 mL/h to 40 mL/hr over the last hour

2,3,4 (For clients scheduled for a cardiac catheterization, it is important to assess for iodine allergy, verify written consent, and instruct the client NPO for 6-18 hours before the procedure. ORal medications are withheld unless specifically prescribed. A urinary drainage cath is rarely prescribed for this procedure.)

A client is scheduled for a cardiac catheterization. The nurse should do which pre-procedure tasks? SATA 1. Administer all prescribed medications 2. check for iodine sensitivity 3.. verify that written consent has been obtained 4. withhold food and oral fluids before the procedure 5. insert a urinary drainage catheter

2,3,4 (The hemoglobin and hematocrit should be assessed to evaluate blood loss. An elevated INR and PTT and decreased platelet count increase the risk for bleeding. The client may require blood products depending on lab values and severity of bleeding therefore, availability of blood products should be confirmed by calling the blood bank. Close monitoring of blood loss from the mediastinal chest tubes should be done. Warfarin is an anticoagulant that will increase bleeding Anticoagulation should be held at this time. Information is needed on the type of valve replacement. For a mechanical heart valve, the INR is kept at 2-3.5. Tissue valves do not require anticoagulation. Dopamine should NOT be initiated if the client is hypotensive from hypovolemia. Fluid volume assessment should be done first. Volume replacement should be initiated in a hypovolemic client prior to starting an inotrope such as dopamine)

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? SATA? 1 administer warfarin 2. check the post-op CBC, INR, PTT, and platelet levels 3 Confirm availability of blood products 4. Monitor the mediastinal chest tube drainage 5 Start a dopamine drip for a systolic BP < 100 mmHG

2 (the nurse should immediately assess BP since nitroprusside and furosemide can cause severe hypotension from a decrease in preload and afterload. If the client is hypotensive, the nitroprusside dose should be reduced or discontinued. Urine output should then be monitored to make sure there is adequate renal perfusion. A 12 lead EKG is performed if the client experiences chest pain. A reduction in pulmonary artery pressures should improve the pulmonary congestion and lung sounds)

A pulmonary artery cath 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: 1. 12 lead EKG 2 BP 3.. lung sounds 4 urine output

2 (The nurse should verify that the HCP has requested to hold the metformin prior to any procedure requiring dye such as a cardiac cath. due to the increased risk of lactic acidosis. Additionally, the drug will usually be withheld for up to 48 hrs following a procedure involving dye. while it clears the clients system. The HCP may prescribe sliding scale insulin during this time if needed. Regardless of how or when the medication is administered, the med should be withheld. The amount of protein in the clients diet prior to cardiac cath has no correlations with the med or test)

An older client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization The nurse should verify the HCP has written a prescription to: 1. limit the amount of protein in the diet prior to the cardiac cath 2 withhold the metformin prior to the cardiac cath 3 administer the metformin with only a sip of water prior to the cardiac cath 4. give metformin before breakfast

2 (most cardiac surgical clients have a median sternotomy incision, which takes 3 months to heal. Measures that promote healing include avoiding heavy lifting, performing muscle reconditioning exercises, and using caution when driving. Showering or bathing is allowed as long as the incision is well approximated with no open areas or drainage. Activities should gradually be resumed on discharge)

Before a clients discharge after mitral valve replacement surgery, the nurse should evaluate the clients understanding of postsurgery activity restrictions. the client should avoid which activity until after the 1 month postdischarge appointment with the surgeon? 1. showering 2. lifting anything heavier than 10 lb 3. a program of gradually progressive walking 4. light housework

1,4,5 (Daily dental care including brushing the teeth twice a day, and flossing once a day and freq checkups by a dentist who is informed of the clients condition are required to maintain good oral health. The client can use a regular brush, it is not necessary to avoid an electric brush. Taking antibiotics prior to certain dental procedures is only recommended if the client has a prosthetic valve or heart transplant. It is not necessary to use antibiotic mouthwash)

Good dental care is 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? SATA 1. brush teeth at least twice a day 2. avoid the use of an electric toothbrush 3 take an antibiotic prior to oral surgery 4 floss the teeth at least once a day 5. have regular dental checkups 6. rinse the mouth with an antibiotic mouthwash once a day

4 (management of postop pain is a priority for the client after surgery, including valve replacement surgery The client and family should be informed that pain will be assessed by the nurse and medications will be given to relieve pain. The client will stay in the ICU as long as monitoring and intensive care are needed. SEnsory depreivation and overload, high noise levels and disrupted sleep and rest patterns are some environmental factors that affect recovery from valve replacement surgery)

In preparing the client and the family for a postoperative stay in the ICU after open heart surgery, the nurse should explain: 1 The client will remain in ICU for 5 days 2. The client will sleep most of the time while in the ICU 3. noise and activity within the ICU are minimal 4. The client will receive medication to relieve pain

1 (Many factors help prevent wound infection, including washing hands carefully, using sterile prepackaged supplies and equipment, cleaning the incision area well, and disposing of soiled dressings properly. However most authorities say the single most effective measure is to wash hands effectively. )

The most effective measure the nurse can use to prevent wound infection when changing a clients dressing after coronary artery bypass surgery is to: 1. observe careful handwashing procedures 2. clean the incisional area with antiseptic 3. use prepackaged sterile dressings to cover the incision 4 place soiled dressings in a waterproof bag before disposing of them

1 (in an immobilized client calcium leaves the bone and concentrates in the ECF. When large amounts of calcium passes thru the kidneys, calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include ensuring liberal fluid intake (unless contraindicated) A diet rich in acid should be provided to keep the urine acidic, which increases the solubility of calcium. PReventing constipation is not associated with excess calcium excretion. Limiting foods rich in Ca, such as dairy, will help prevent renal calculi)

Which measure should the nurse institute to help prevent complications associated with excessive calcium excretion following cardiac surgery to replace an aortic valve? 1 insure liberal fluid intake 2. provide an alkaline-ash diet 3. prevent constipation 4. enrich the clients diet with dairy products

3 (INR is used to assess effectiveness of the warfarin therapy INR is the prothrombin time ratio that would be obtained if the thromboplastin reagent from the WHO was used for the plasma test It is now the recommended method to monitor effectiveness of warfarin. Generally, the INR for clients administered warfarin should range from 2 to 3. In the past prothrombin time was used to assess effectiveness of warfarin sodium and was maintained at 1.5-2.5 times the control value Partial thromboplastin time is used to assess the effectiveness of heparin therapy. Fresh frozen plasma or vitamin K is used to reverse warfarin anticoagulant effect, whereas, protamine sulfate reverses the effects of heparin. Warfarin will help prevent blood clots.)

The nurse should teach the client who is receiving warfarin sodium that 1. partial thromboplastin time values determine the dosage of warfarin 2. protamine sulfate is used to reverse the effects of warfarin 3. international normalized ratio (INR) is used to assess effectiveness 4. warfarin will facilitate clotting of the blood

1 (verbalized concerns from this client may stem from anxiety over the changes in the body after open heart surgery. Although the client may experience depression related to altered health status or may have lack of knowledge regarding the postop course, the client is pointing out changes in body image. The client is not concerned with altered tissue perfusion)

Three days after surgery for mitral valve replacement, the client tells the nurse there is a clicking noise coming from the clients chest incision. The nurses response should reflect the understanding that the client may be experiencing: 1. anxiety related to altered body image 2. depression related to altered health status 3. altered tissue perfusion 4. lack of knowledge regarding the postoperative course