Chapter 40: Valvular Diseases Flashcards
A client with aortic stenosis presents with dyspnea and angina. Upon auscultation, the nurse hears a harsh systolic murmur at the right upper sternal border. What is the most likely cause of this murmur?
A. Tricuspid regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Pulmonary stenosis
B. Aortic stenosis
Rationale: A harsh systolic murmur heard at the right upper sternal border is characteristic of aortic stenosis.
Which of the following is a typical clinical manifestation of mitral regurgitation?
A. Orthopnea and bilateral crackles in the lungs
B. Chest pain radiating to the left arm
C. Jugular venous distension and hepatomegaly
D. A loud S1 with a mid-systolic click
A. Orthopnea and bilateral crackles in the lungs
Rationale: Mitral regurgitation can lead to pulmonary congestion, resulting in orthopnea and crackles.
A nurse is assessing a client with mitral valve prolapse. Which auscultatory finding would the nurse most likely hear?
A. S3 gallop
B. S4 gallop
C. Holosystolic murmur at the apex
D. Mid-systolic click
D. Mid-systolic click
Rationale: A mid-systolic click is characteristic of mitral valve prolapse.
Which of the following is the primary characteristic of aortic regurgitation?
A. Systolic murmur
B. Diastolic murmur
C. Opening snap
D. Loud S1
B. Diastolic murmur
Rationale: Aortic regurgitation presents with a diastolic murmur, often described as a “blowing” sound.
A patient with severe mitral stenosis is admitted to the hospital. Which clinical manifestation is most likely present?
A. Dry cough and fever
B. Tachycardia and hypotension
C. Dyspnea on exertion and fatigue
D. Pitting edema in the lower extremities
C. Dyspnea on exertion and fatigue
Rationale: Mitral stenosis causes impaired left atrial emptying, leading to pulmonary congestion, dyspnea, and fatigue.
In a client with aortic stenosis, what physical finding would the nurse expect upon palpation of the carotid arteries?
A. Diminished or delayed carotid pulse
B. Bounding carotid pulse
C. Symmetrical pulsations
D. Absent carotid pulse
A. Diminished or delayed carotid pulse
Rationale: Aortic stenosis causes obstruction of blood flow, resulting in diminished or delayed carotid pulses.
A nurse is caring for a client who has had a mechanical valve replacement. What is the most important intervention for this patient?
A. Administering antibiotics before procedures
B. Monitoring for signs of stroke
C. Teaching the patient about anticoagulation therapy
D. Encouraging deep breathing exercises
C. Teaching the patient about anticoagulation therapy
Rationale: Clients with mechanical valves require lifelong anticoagulation therapy to prevent thromboembolic events.
A client with mitral regurgitation reports increasing fatigue and difficulty breathing. What action should the nurse take next?
A. Administer a diuretic
B. Encourage the patient to rest
C. Assess the patient’s blood pressure
D. Notify the healthcare provider immediately
D. Notify the healthcare provider immediately
Rationale: Worsening fatigue and dyspnea may indicate worsening heart failure, which requires immediate intervention.
Which of the following is a key difference between mechanical and biological heart valves?
A. Mechanical valves require long-term anticoagulation
B. Biological valves are more durable than mechanical valves
C. Mechanical valves are more prone to infection than biological valves
D. Biological valves are less likely to cause blood clots than mechanical valves
A. Mechanical valves require long-term anticoagulation
Rationale: Mechanical valves require lifelong anticoagulation therapy to prevent thromboembolic events, whereas biological valves do not.
A client who has had a mitral valve replacement with a biological valve asks when the anticoagulation therapy can be discontinued. What is the nurse’s best response?
A. “You may stop the anticoagulants after 6 months.”
B. “You will need to take anticoagulants for the rest of your life.”
C. “Anticoagulants are needed only during periods of high physical activity.”
D. “Anticoagulants are not necessary for biological valve replacements.”
D. “Anticoagulants are not necessary for biological valve replacements.”
Rationale: Biological valve replacements generally do not require long-term anticoagulation, but some patients may need short-term therapy post-operatively.
A nurse is assessing a client with aortic regurgitation. Which auscultation finding is most commonly associated with this condition?
A. A loud, harsh systolic murmur
B. A diastolic murmur with a “blowing” sound
C. A mid-systolic click
D. An S3 gallop
B. A diastolic murmur with a “blowing” sound
Rationale: Aortic regurgitation presents with a diastolic murmur, often described as a “blowing” sound.
In a client with aortic stenosis, which of the following is a potential complication?
A. Hypertension
B. Acute pulmonary edema
C. Arrhythmias
D. Cardiac tamponade
C. Arrhythmias
Rationale: Aortic stenosis can lead to left ventricular hypertrophy, increasing the risk of arrhythmias.
What clinical finding is indicative of mitral valve prolapse?
A. Systolic click and murmur
B. Systolic ejection murmur
C. Diastolic murmur
D. Opening snap and diastolic rumble
A. Systolic click and murmur
Rationale: Mitral valve prolapse is typically associated with a systolic click and murmur.
Which of the following is the most common cause of aortic stenosis in older adults?
A. Rheumatic fever
B. Degenerative calcification
C. Congenital heart defects
D. Endocarditis
B. Degenerative calcification
Rationale: In older adults, aortic stenosis is commonly caused by degenerative calcification of the valve.
A patient with severe mitral stenosis is being prepared for valve replacement. Which of the following is a priority preoperative nursing intervention?
A. Administering antibiotics to prevent endocarditis
B. Instructing the patient to perform deep breathing exercises
C. Providing a blood transfusion
D. Teaching the patient about anticoagulation therapy
A. Administering antibiotics to prevent endocarditis
Rationale: Antibiotics are given preoperatively to prevent infection, particularly in patients with valve disease.
Which of the following findings would be most concerning in a client with a mechanical valve replacement?
A. Slightly increased heart rate
B. Mild shortness of breath after exertion
C. A history of recent deep vein thrombosis
D. A positive blood culture for bacteria
D. A positive blood culture for bacteria
Rationale: A positive blood culture indicates possible infective endocarditis, which requires urgent treatment.
Which of the following is a primary nursing intervention for a patient with aortic regurgitation?
A. Administering vasodilators to reduce afterload
B. Restricting fluid intake to prevent fluid overload
C. Encouraging ambulation to improve circulation
D. Limiting the patient’s sodium intake
A. Administering vasodilators to reduce afterload
Rationale: Vasodilators help reduce afterload and improve cardiac output in aortic regurgitation.
In the assessment of a client with mitral stenosis, the nurse may auscultate which of the following sounds?
A. A loud S1
B. A mid-systolic click
C. A high-pitched diastolic murmur
D. A diastolic rumble with an opening snap
D. A diastolic rumble with an opening snap
Rationale: Mitral stenosis typically produces a diastolic rumble with an opening snap.
After mitral valve replacement, a client receives a prescription for warfarin. What is the nurse’s primary concern?
A. The client may need frequent blood transfusions.
B. The client is at increased risk for bleeding.
C. The client will need lifelong anticoagulation therapy.
D. The client must avoid high-fat foods.
B. The client is at increased risk for bleeding.
Rationale: Warfarin increases the risk of bleeding, requiring careful monitoring of the client’s INR.
In a patient with aortic regurgitation, which of the following would be an early compensatory mechanism?
A. Increased heart rate
B. Decreased cardiac output
C. Left ventricular hypertrophy
D. Pulmonary edema
C. Left ventricular hypertrophy
Rationale: Left ventricular hypertrophy occurs as the heart compensates for the increased volume load in aortic regurgitation.
Which of the following is a characteristic finding of severe mitral regurgitation?
A. Systolic murmur radiating to the axilla
B. Diastolic rumble heard best at the apex
C. Harsh systolic murmur heard at the right upper sternal border
D. High-pitched diastolic murmur over the aortic area
A. Systolic murmur radiating to the axilla
Rationale: A systolic murmur radiating to the axilla is characteristic of mitral regurgitation.
Which of the following conditions is commonly associated with mitral valve prolapse?
A. Acute pericarditis
B. Marfan syndrome
C. Rheumatic heart disease
D. Endocarditis
B. Marfan syndrome
Rationale: Mitral valve prolapse is often seen in individuals with Marfan syndrome, a connective tissue disorder.
Which of the following describes the clinical manifestation of severe aortic stenosis?
A. Syncope, angina, and dyspnea
B. Pulsus alternans and widened pulse pressure
C. Cyanosis and clubbing of the fingers
D. Systolic murmur radiating to the neck
A. Syncope, angina, and dyspnea
Rationale: Severe aortic stenosis can lead to reduced cardiac output, resulting in syncope, angina, and dyspnea.
Which of the following is the priority postoperative nursing care for a client who has undergone valve replacement surgery?
A. Maintaining a patent airway
B. Monitoring for signs of infection
C. Encouraging ambulation to prevent deep vein thrombosis
D. Monitoring coagulation levels if anticoagulation therapy is prescribed
D. Monitoring coagulation levels if anticoagulation therapy is prescribed
Rationale: Close monitoring of coagulation levels is essential to prevent bleeding or clot formation after valve replacement.
A nurse is caring for a patient with a mechanical heart valve. Which of the following is essential for the nurse to monitor during anticoagulation therapy?
A. Serum potassium levels
B. Sodium levels
C. INR levels
D. Blood glucose levels
C. INR levels
Rationale: The International Normalized Ratio (INR) must be closely monitored to ensure that the patient is within the therapeutic range for anticoagulation.
