ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 24 : Caring for Clients With Valvular Disorders of the Heart Questions
Question 1 of 5
The nurse is caring for a client with mitral stenosis. Which assessment finding would cause the greatest concern in providing nursing care to this client?
Correct Answer: A
Rationale: A damaged mitral valve leads to incomplete emptying of the left atrium and accumulation of blood resulting in increased pressure. As the backup of blood continues, pressure is increased into the lungs and right ventricle and cardiac output decreases.
Question 2 of 5
Before an invasive procedure, a client is prescribed antibiotics. The nurse understands the reason for this preventative action is to avoid which complication?
Correct Answer: B
Rationale: Infective endocarditis can compound valvular damage but can be minimized with the preventative use of antibiotics before invasive procedures and dental work. Rheumatic heart disease is associated with the original cause of valve disease and is not prevented with prophylactic antibiotic use. Although congestive heart failure is a complication associated with valvular disease, prophylactic antibiotic therapy is not prescribed for prevention. One type of valvular disease is mitral valve regurgitation. When this occurs rapidly, the heart is less able to compensate, causing the client to develop signs of cardiogenic shock leading to pulmonary congestion. The use of antibiotics is not meant to avoid this complication.
Question 3 of 5
Before administering digoxin to a client with valvular disease, the nurse assesses the apical heart rate as 62 beats/minute. The client's usual rate ranges between 66 to 72 beats/minute. Which is the best action for the nurse to take?
Correct Answer: C
Rationale: A heart rate of 62 beats/minute falls within the normal range for administration of this drug. Holding the medication would not be recommended unless a specific prescription was detailed to do so. The nurse may decide to recheck the pulse but this is not required. Notifying the physician of normal findings is not efficient use of time or resources.
Question 4 of 5
A client with progressive mitral valve prolapse is experiencing sympathetic nervous system symptoms in addition to prolapse symptoms. Which teaching point should be stressed by the nurse to minimize these effects?
Correct Answer: C
Rationale: The symptoms associated with sympathetic nervous response (anxiety, agitation, nervousness, and palpitations) are often managed with antianxiety medications and advisement to avoid caffeine and over-the-counter medications that contain stimulants. Periodic antibiotic therapy use before an invasive procedure is not associated with sympathetic nervous system symptoms. Low-dose aspirin is used to prevent thrombus formation. Decreasing fluid and sodium intake is indicated for the control of congestive failure.
Question 5 of 5
The nurse is providing teaching to a post-valve replacement client. Which activit(ies) would require prophylactic antibiotic use? Select all that apply.
Correct Answer: B,E
Rationale: Dental cleaning/care and colonoscopy are invasive procedures that can disturb the normal bacteria located in residence and place a valve replacement client at risk for infective endocarditis. Vision screening, echocardiogram, MRI, and chelation therapy are not invasive procedures and do not mobilize bacteria.