Exam II Nursing Managment of Valvular disorders Flashcards
A nurse has a patient with a new diagnosis of valvular heart disease. What are the typical assessments the nurse would make? Select all that apply. A) Symptoms of syncope and dizziness B) Splenomegaly C) Dysrhythmias D) Dyspnea on exertion E) Multiple respiratory infections
A) Symptoms of syncope and dizziness
C) Dysrhythmias
D) Dyspnea on exertion
E) Multiple respiratory infections
The nurse would also be on the look out for angina, decreased activity intolerance, increased coughing, Paroxsymal nocturnal dyspnea
The nurse suspects left sided valve damage based of what findings? Select all that apply. A) PND B) Increased pulmonary artery pressure C) Ventricular tachycardia D) Increased cardiac output E) Left ventricular hypertrophy
A) PND (paroxsymal nocturnal dyspnea)
B) Increased artery pressure
E) Left ventricular hypertrophy
Explanations:
C) Ventricular tachycardia is incorrect. Atrial fibrillation is more likely to be seen.
D) Increased cardiac output is incorrect. The cardiac output would be decreased
A patient with a recent diagnosis of aortic stenosis is complaining of chest pains. He has a history of angina pectoris. He takes nitroglycerine for the angina. What is likely to occur in this patient? A) Dysrhythmias B) Myocardial Infarction C) Elevated blood pressure D) Syncope
D) Syncope
The patient is likely to experience syncope, because nitroglycerine decreases blood return to the heart, thus decreasing cardiac output further.
Nurses caring for patients with valvular disorders need to educate the patient on the following. Select all that apply.
A) Weight gain of 3 lbs in 1 day, or 5 lbs in 1 week
B) Minimizing the risk of developing infective endocarditis
C) Energy conservation
D) Avoidance of alcohol and caffeine
All of the above.
Nursing interventions for a patient admitted for a possible valvular disorder include? Select all that apply.
A) Pertinent vital signs
B) Heart and lung auscultation
C) Monitoring for heart failure signs and symptoms
D) Elevated HOB during sleep
E) Increase fluid and sodium intake
A) Pertinent vital signs (i.e, HR, B/P, RR)
B) Heart and Lung auscultation (assess for murmur and crackles in the lungs)
C) Monitoring for heart failure is a major complication
D) Elevated HOB during sleep, particularly those who experience pulmonary congestion
Explanations:
E) Increase fluid and sodium intake is incorrect. The nurse should maintain fluid and sodium restrictions
A patient with mitral stenosis is scheduled for a valvuloplasty. The nurse knows that the patient will NOT require what post-procedure therapy?
Continuous anticoagulation therapy
What is the priority nursing intervention for a patient post-surgical valvuloplasty or valve-replacement? Select all that apply. A) Oxygen 2 L via nasal cannula B) Elevate legs C) Continuous glucose checks q 4 hrs D) Hemodynamic monitoring E) Anesthesia recovery
D) Hemodynamic monitoring
E) Anesthesia recovery
Valvuloplasties require general anesthesia and often cardiopulmonary bypass. So, these interventions are important! V/S every 5-15 min until recovered from anesthesia. Ausculate heart sounds q 4 hours. Frequent neurological, respiratory, and cardiovascular assessments are also essential!
The other answers are just wrong
A patient is concerned about possible risks regarding a valvuloplasty. The nurse best answers this concern with the following response.
A) Valvuloplasties are safe and generally have no complications
B) You can expect to be on dialysis for the remainder of your life
C) You can expect to have some degree of mitral regurgitation after the procedure
D) To be on lifelong anticoagulation therapy
C) You can expect to have some degree of mitral regurgitation after the procedure
- Other possible complications include bleeding at catheter site, emboli, and left-to-right atrial shunts
D) is incorrect because it is not required for patients who undergo a valvuloplasty to be on continuous anticoagulation therapy.
The other answers are completely fictitious
A patient post-op balloon valvuloplasty is being transferred to the med-surg floor. The nurse can anticipate what nursing interventions? Select all that apply.
A) Monitor for heart failure and emboli
B) Incision care
C) Educate patient on limiting activity for 6 weeks
D) Assessing heart sounds q 4 hrs
E) Monitoring Troponin I levels
A) Monitor for heart failure and emboli
B) Incision care
C) Educate patient on limiting activity for 6 weeks
D) Assessing heart sounds q 4 hrs
Care is the same as cardiac catheterization
A patient is nervous about possible complications following a valve-replacement procedure. The nurse demonstrates an understanding of possible complications based on which statement?
A) Valve-replacements typically cause significant sinus bradycardia and require a pacemaker
B) Create a degree of stenosis
C) Can cause insulin sensitivity
D) There are no risks associated with this procdeure
B) Create a degree of stenosis
Other complications include bleeding, thromboembolism, infection, HF
Mechanical valves have significant complications associated with them. The nurse understands these complications are?
Thromboemboli and long-term use of required anticoagulants
The nurse is giving discharge instructions to a patient who recently had valve replacement surgery. You are a student nurse observing her. You anticipate which discharge instructions? Select all that apply.
A) Anticoagulation therapy
B) Prevention of infective endocarditis
C) Keeping surgical site covered and moist
D) Follow-up blood laboratory studies
E) Echocardiogram 3-4 weeks after discharge and then q 1-2 years
A) Anticoagulation therapy
B) Prevention of infective endocarditis
D)Follow-up blood laboratory studies (INRs 2-3.5 for mitral valve replacement and 1.8-2.2 for aortic valve replacement)
E) Echocardiogram repeats
Which of the following instructions should a nurse provide a patient with a history of rheumatic fever before the patient has dental work? A) Administration of Aspirin B) Administration of Steroids C) Avoid any kind of activities D) To take prophylactic antibiotics
C) To take prophylactic antibiotics
The patient with which of the following characteristics is considered high risk for the development of infective endocarditis?
A) Hypertrophic cardiomyopathy
B) Acquired valvular dysfunction
C) Mitral valve prolapse with valvular regurgitation
D) Cyanotic congenital malformations
D) Cyanotic congenital malformations
A, B, and C only pose a moderate risk to infective endocarditis
