Cardiovascular System | Valvular Diseases NCLEX Quiz 21

1. 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:

Chicken pox

Poliomyelitis

Rheumatic fever

Meningitis

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

Explanation

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

2. When teaching a client with a cardiac problem. who is on a high-unsaturated fatty-acid diet. the nurse should stress the importance of increasing the intake of:

Enriched whole milk

Red meats. such as beef

Vegetables and whole grains

Liver and other glandular organ meats

Vegetables and whole grains are low in fat and may reduce the risk for heart disease.

Explanation

Vegetables and whole grains are low in fat and may reduce the risk for heart disease.

3. Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation?

Exertional dyspnea

Confusion

Elevated creatine phosphokinase concentration

Chest pain

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.

Explanation

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.

4. Cholesterol. frequently discussed in relation to atherosclerosis. is a substance that:

May be controlled by eliminating food sources

Is found in many foods. both plant and animal sources

All persons would be better off without because it causes the disease process

Circulates in the blood. the level of which usually decreases when unsaturated fats are substituted for saturated fats.

Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats.

Explanation

Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats.

5. The nurse expects that a client with mitral stenosis would demonstrate symptoms associated with congestion in the:

Aorta

Right atrium

Superior vena cava

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.

Explanation

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.

6. 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 manual toothbrush

An electric toothbrush

An irrigation device

Dental floss

Daily dental care and frequent checkups by a dentist who is informed about the client’s condition are required to maintain good oral health.Options B. C. and D: 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.

Explanation

Daily dental care and frequent checkups by a dentist who is informed about the client’s condition are required to maintain good oral health.Options B. C. and D: 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.

7. 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?

Medication therapy

Diet modification

Activity restrictions

Dental care

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.

Explanation

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.

8. A 2-gram sodium diet is prescribed for a client with severe hypertension. The client does not like the diet. and the nurse hears the client request that the spouse "Bring in some good home-cooked food." It would be most effective for the nurse to plan to:

Call in the dietician for client teaching

Wait for the client’s family and discuss the diet with the client and family

Tell the client that the use of salt is forbidden. because it will raise BP

Catch the family members before they go into the client’s room and tell them about the diet.

Clients’ families should be included in dietary teaching; families provide support that promotes adherence.

Explanation

Clients’ families should be included in dietary teaching; families provide support that promotes adherence.

9. A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The complication the nurse will constantly observe for is:

Presence of heart murmur

Systemic emboli

Fever

Congestive heart failure

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.Options A. C. and D: 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.

Explanation

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.Options A. C. and D: 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.

10. What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Check all that apply.

The RR intervals are relatively consistent

One P wave precedes each QRS complex

Four to eight complexes occur in a 6-second strip

The ST segment is higher than the PR interval

The QRS complex ranges from 0.12 to 0.2 seconds

(1) The consistency of the RR interval indicates a regular rhythm. (2) A normal P wave before each complex indicates the impulse originated in the SA node.Option C: The number of complexes in a 6-second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100.Option D: Elevation of the ST segment is a sign of cardiac ischemia and is unrelated to the rhythm.Option E: The QRS duration should be less than 0.12 seconds; the PR interval should be 0.12 to 0.2 seconds.

Explanation

(1) The consistency of the RR interval indicates a regular rhythm. (2) A normal P wave before each complex indicates the impulse originated in the SA node.Option C: The number of complexes in a 6-second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100.Option D: Elevation of the ST segment is a sign of cardiac ischemia and is unrelated to the rhythm.Option E: The QRS duration should be less than 0.12 seconds; the PR interval should be 0.12 to 0.2 seconds.

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