*IMPORTANT* Valvular Heart Disorders 34Qw/exp

When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of a. valvular heart disease b. pulmonary hypertension c. superior vena cava syndrome d. hypertrophy of the right ventricle

a. valvular heart disease Rationale: Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.

This is considered the hardening of the valves. The valve does not open completely and blood flow through the valve is reduced a-Regurgitation b-Stenosis c-Mitral Valve Prolapse d-Valve Prolapse

b-Stenosis Stenosis (hardening): the valve does not open completely and blood flow through the valve is reduced

A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The complication the nurse will constantly observe for is: a-Presence of heart murmur b-Systemic emboli c-Fever d-Congestive heart failure

b-Systemic emboli Emboli are the major problem; those arising in the right heart chambers will terminate in the lungs and left chamber emboli may travel anywhere in the arteries. Heart murmurs, fever, and night sweats may be present, but do not indicate a problem with emboli. CHF may be a result, but this is not as dangerous an outcome as emboli

The nurse is listening to a client's heartbeat and is focusing on the second heart sound. Which heart valves produce this sound? a. Aortic and tricuspid b. Aortic and pulmonic c. Mitral and pulmonic d. Mitral and tricuspid

b. Aortic and pulmonic

The nurse feels pulsations on a client's right sternal border, second space. What does this finding suggest to the nurse? a. A prolapsed mitral valve b. Aortic stenosis c. Nothing. This is a normal finding. d. Tricuspid valve regurgitation

b. Aortic stenosis

A patient is scheduled for a percutaneous transluminal valvuloplasty. The nurse understands that this procedure is indicated for a. any patient with aortic regurgitation b. older patients with aortic regurgitation c. older patients with stenosis of any valve d. young adult patients with mild mitral valve stenosis

c. older patients with stenosis of any valve Rationale: This procedure has been used for repair of pulmonic, tricuspid, and mitral stenosis, but usually for those patients that are poor surgical risks.

Which heart valves are closed to prevent backflow of blood into the atria during diastole? List all that apply. a) Tricuspid valve b) Pulmonary valve c) Mitral valve d) Aortic valve e) Pneumonic valve

Answer: a. c. The tricuspid valve and the mitral valve are closed to prevent backflow of blood during diastole. what is backflow called?

List in order the pathway of blood through the heart from deoxygenated to oxygenated blood. a) Left ventricle b) Right ventricle c) Left atrium d) Right atrium

Answer: d, b, c, a. Blood goes from the right atrium to the right ventricle, then to the lungs, the left atrium and out the left ventricle.

A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral stenosis? a-Pulmonary hypertension b-Left-sided heart failure c-MI d-Left ventricular hypertrophy

a-Pulmonary hypertension Feedback Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation.

Drugs that the nurse would expect to be prescribed for patients with a mechanical valve replacement include a. oral nitrates b. anticoagulants c. atrial antidysrhythmics d. beta adrenergic blocking agents

b. anticoagulants Rationale: Patients with mechanical valves have an increased risk for thrombus formation. Therefore prophylactic anticoagulation therapy is used to prevent thrombus formation and systemic or pulmonary embolization. Nitrates are contraindicated for the patient with aortic stenosis because an adequate preload is necessary to open the stiffened aortic valve. Antidysrhythmics are used only if dysrhythmias occur, and alpha or beta adrenergic blocking agents may be used to control the HR as needed.

Dyspnea, fatigue, increased pulmonary artery pressure, and decreased cardiac output are indicitive of... a-MI b-Right sided valve damage c-Left sided valve damage d-JVD

c-Left sided valve damage why? which valve?

A 68-year-old woman is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have any symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the nice lady, the nurse would most likely learn that the client's childhood health history included: a-Chicken pox b-poliomyelitis c-Rheumatic fever d-meningitis

c-Rheumatic fever Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis.

The nurse expects that a client with mitral stenosis would demonstrate symptoms associated with congestion in the: a-Aorta b-Right atrium c-Superior vena cava d-Pulmonary circulation

d-Pulmonary circulation When mitral stenosis is present, the left atrium has difficulty emptying its contents into the left ventricle. Hence, because there is no valve to prevent backward flow into the pulmonary vein, the pulmonary circulation is under pressure.

During the cardiac assessment, the nurse learns a client had rheumatic heart fever as a child. For which of the following cardiac conditions should this client be assessed? a. Pulmonic stenosis b. Aortic stenosis c. Mitral regurgitation d. Mitral stenosis

d. Mitral stenosis all of em really but this is the big one

When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patient says, 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 wear a medic alert bracelet to identify my valve and anticoagulant therapy d. the biggest risk I have during invasive health procedures is bleeding because of my anticoagulants

d. the biggest risk I have during invasive health procedures is bleeding because of my anticoagulants Rationale: The greatest risk to a patient who has an artificial valve is the development of endocarditis with invasive medical or dental procedures; before any of these procedures, antibiotic prophylaxis is necessary to prevent infection. Health care providers must be informed of the presence of the valve and the anticoagulation therapy, but the most important factor is using antibiotic prophylaxis before invasive procedures.

Left Atrium enlargement in mitral stenosis can cause this time of arrythmia (most common)? 1-A fib 2-Ischemia 3--V-tach

1-A fib why?

What are the FIVE major acquired left-sided valvular lesions?

1. Mitral stenosis 2. Mitral regurgitation 3. Mitral valve prolapse 4. Aortic stenosis 5. Aortic regurgitation

Less than what cm is considered in Mitral stenosis where hemodynamic changes becomes clinically appearant? 2 4 5 7

2 Feedback normal is 4-6 cm

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? . 1. Ventricular fibrillation 2. Infective endocarditis 3. Rupture of the chordae tendinae 4. Atherosclerosis

3. Rupture of the chordae tendinae

Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include demonstration of the proper use of: a-A manual toothbrush b-An electric toothbrush c-An irrigation device d-Dental floss

A manual toothbrush Daily dental care and frequent checkups by a dentist who is informed about the client's condition are required to maintain good oral health. Use of an electric toothbrush, an irrigation device, or dental floss may cause gums to bleed and allow bacteria to enter mucous membranes and the bloodstream, increasing the risk of endocarditis.

During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would expect to find a. substernal chest pressure. b.a new regurgitant murmur. c.a pruritic rash on the chest. d.involuntary muscle movement.

ANS: B 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

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is apriorityfor the nurse to include? a.Monitor labs for streptococcal antibodies. b.Arrange for placement of a long-term IV catheter. c.Teach the importance of completing all oral antibiotics. d.Encourage the patient to begin regular aerobic exercise.

ANS: B Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in order to eradicate the bacteria, which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line. Rest periods and limiting physical activity to a moderate level are recommended during the treatment for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.

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)? a.Fever, chills, and diaphoresis b.Urine output less than 30 mL/hr c.Petechiae on the inside of the mouth and conjunctiva d.Increase in heart rate of 15 beats/minute with walking

ANS: B 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/minute is normal with exercise.DIF: Cognitive Level: Apply (application) REF: 812

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. shortness of breath on exertion. d. right upper quadrant tenderness.

ANS: C 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.

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is mostappropriate? a."Do you have a history of a heart attack?" b."Is there a family history of endocarditis?" c."Have you had any recent immunizations?" d."Have you had dental work done recently?"

ANS: D Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE.DIF: Cognitive Level: Apply (application) REF: 812TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation? a-Exertional dyspnea b-Confusion c-Elevated creatine phosphokinase concentration d-Chest pain

a-Exertional dyspnea Weight gain, due to fluid retention and worsening heart failure, causes exertional dyspnea in clients with mitral regurgitation. The rise in left atrial pressure that accompanies mitral valve disease is transmitted backward into pulmonary veins, capillaries, and arterioles and eventually to the right ventricle. Signs and symptoms of pulmonary and systemic venous congestion follow.

Because a client has mitral stenosis and is a prospective valve recipient, the nurse preoperatively assesses the client's past compliance with medical regimens. Lack of compliance with which of the following regimens would pose the greatest health hazard to this client? a-Medication therapy b-Diet modification c-Activity restrictions d-Dental care

a-Medication therapy Preoperatively, anticoagulants may be prescribed for the client with advanced valvular heart disease to prevent emboli. Post-op, all clients with mechanical valves and some with bioprostheses are maintained indefinitely on anticoagulation 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 from rheumatic fever. Episodic prophylaxis is required to prevent infective endocarditis after dental procedures or upper respiratory, GI, or GU surgery

Which of the following diagnostic study best differentiates the various types of cardiomyopathy? a. echocardiography b. arterial blood gases c. cardiac catheterization d. endomyocardial biopsy

a. echocardiography Rationale: The echocardiogram is the primary diagnostic tool used to differentiate between the different types of cardiomyopathies and other structural cardiac abnormalities.

A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to nursing assistant personnel (NAP) (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 bracelet

a. obtain and record daily weight c. observe for overt signs of bleeding d. obtain and record vital signs, including pulse oximetry Rationale: The nurse may delegate routine procedures such as obtaining weights and vital signs. The nurse may give specific directions to the nursing assistive personnel (NAP) to observe and report obvious signs of bleeding. The nurse cannot delegate teaching, assessment, or activities that require clinical judgment. Obtaining an apical-radial pulse rate is an assessment.

A patient with infective endocarditis of a prosthetic mitral valve develops a left hemiparesis and visual changes. The nurse expects that collaborative management of the patient will include a. an embolectomy b. surgical valve replacement c. administration of anticoagulants d. higher than usual antibiotic dosages

b. surgical valve replacement Rationale: Drug therapy for patients who develop endocarditis of prosthetic valves is often unsuccessful in eliminating the infection and preventing embolization, and early valve replacement followed by prolonged drug therapy is recommended for these patients.

A client is admitted to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, the nurse formulates interventions with which goal in mind? a-Decreasing blood pressure and increasing mobility b-Increasing blood pressure and reducing mobility c-Stabilizing the heart rate and blood pressure and easing anxiety d-Increasing blood pressure and monitoring fluid intake and output

c-Stabilizing the heart rate and blood pressure and easing anxiety Feedback For a client with an aneurysm, nursing interventions focus on stabilizing the heart rate and blood pressure, to avoid aneurysm rupture. Easing anxiety also is important because anxiety and increased stimulation may speed the heart rate and boost blood pressure, precipitating aneurysm rupture.

A 21-year-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? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

c. Lifelong anticoagulant therapy will be 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.

A mechanical prosthetic valve is most likely to be preferred over a biologic valve for valve replacement in a a. 41-year-old man with peptic ulcer disease b. a 22-year-old woman who desires to have children c. a 35-year-old man with a history of seasonal asthma d. 62-year-old woman with early Alzheimer's disease

c. a 35-year-old man with a history of seasonal asthma Rationale: Mechanical prosthetic valves require long-term anticoagulation, and this is a factor in making a decision about the type of valve to use for replacement. Patients who cannot take anticoagulant therapy, such as women of childbearing age, patients at risk for hemorrhage, or patient who may not be compliant with anticoagulation therapy, may be candidates for the less durable biologic valves.

A patient is scheduled for an open surgical valvuloplasty of the mitral valve. In preparing the patient for surgery, the nurse recognizes that 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 they do with valve replacement

c. the operative mortality rate is lower in valve repair than in valve replacement Rationale: Repair of mitral or tricuspid valves has a lower operative mortality rate than does replacement and is becoming the surgical procedure of choice for these valvular diseases. Open repair is more precise than closed repair and requires cardiopulmonary bypass during surgery. All types of valve surgery are palliative, not curative, and patients require lifelong health care. Anticoagulation therapy is used for all valve surgery for at least some time postoperatively.