Valvular Heart Disorders
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
What is A?
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.
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
What is A?
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.
In which of the following disorders would the nurse expect to assess sacral edema in a bedridden client?
A. Diabetes
B. Pulmonary emboli
C. Renal failure
D. Right-sided heart failure
What is D?
The most accurate area on the body to assess dependent edema in a bed-ridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.
Which of the following terms describes the force against which the ventricle must expel blood?
A. Afterload
B. Cardiac output
C. Overload
D. Preload
What is A?
Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.
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. Chickenpox
B. Poliomyelitis
C. Rheumatic fever
D. Meningitis
What is C?
Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis.
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
What is B?
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
Which of the following symptoms might a client with right-sided heart failure exhibit?
A. Adequate urine output
B. Polyuria
C. Oliguria
D. Polydipsia
What is C?
Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria.
A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin (Lanoxin), a nurse checks the client’s most recent:
A. Digoxin level
B. Sodium level
C. Potassium level
D. Creatinine level
What is C?
The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.
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
What is A?
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.
When developing a teaching plan for a client with endocarditis, which of the following points is most essential for the nurse to include?
A. “Report fever, anorexia, and night sweats to the physician.”
B. “Take prophylactic antibiotics after dental work and invasive procedures.”
C. “Include potassium-rich foods in your diet.”
D. “Monitor your pulse regularly.”
What is A?
The most essential teaching point is to report signs of relapse, such as fever, anorexia, and night sweats, to the physician. To prevent further endocarditis episodes, prophylactic antibiotics are taken before and sometimes after dental work, childbirth, or GU, GI, or gynecologic procedures. A potassium-rich diet and daily pulse monitoring aren’t necessary for a client with endocarditis.
Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility?
A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Diuretics
D. Inotropic agents
What is D?
Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output.
A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for:
A. Thrombocytopenia and weight gain
B. Anorexia, nausea, and visual disturbances
C. Diarrhea and hypotension
D. Fatigue and muscle twitching
What is B?
The first signs and symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other dysrhythmias.
Which of the following foods should the nurse teach a client with heart failure to avoid or limit when following a 2-gram sodium diet?
A. Apples
B. Tomato juice
C. Whole wheat bread
D. Beef tenderloin
What is B?
Canned foods and juices, such as tomato juice, are typically high in sodium and should be avoided in a sodium-restricted diet.
Which of the following actions is the appropriate initial response to a client coughing up pink, frothy sputum?
A. Call for help
B. Call the physician
C. Start an I.V. line
D. Suction the client
What is A?
Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the client is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions would immediately follow.
Which of the following nursing diagnoses would be appropriate for a client with heart failure? Select all that apply.
A. Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output.
B. Activity intolerance related to increased cardiac output.
C. Decreased cardiac output related to structural and functional changes.
D. Impaired gas exchange related to decreased sympathetic nervous system activity.
What is A and C?
HF is a result of structural and functional abnormalities of the heart tissue muscle. The heart muscle becomes weak and does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle and backs up into the left atrium, and eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition, this pooling leads to thrombus formation and ineffective tissue perfusion because of the decrease in blood flow to the other organs and tissues of the body. Typically, these clients have an ejection fraction of less than 50% and poorly tolerate activity. Activity intolerance is related to a decrease, not an increase, in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity.
A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client’s medical history included DM, HTN, and heart failure. Which of the following disorders should the nurse suspect?
A. Pulmonary edema
B. Pneumothorax
C. Cardiac tamponade
D. Pulmonary embolus
What is A?
SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy sputum are late signs of pulmonary edema.