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
- Rheumatic fever
2. Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation?
- Exertional dyspnea
- Elevated creatine phosphokinase concentration
- Chest pain
3. The nurse expects that a client with mitral stenosis would demonstrate symptoms associated with congestion in the:
- Right atrium
- Superior vena cava
- Pulmonary circulation
4. 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
5. 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
6. 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
- Congestive heart failure
7. 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.
8. 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
9. 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.
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
Answers and Rationales
- C. Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis.
- 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.
- D. 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.
- 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.
- 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 blood stream, increasing the risk of endocarditis.
- 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.
- D. Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats.
- C. Vegetables and whole grains are low in fat and may reduce the risk for heart disease.
- B. Clients’ families should be included in dietary teaching; families provide support that promotes adherence.
- A and B. (A) The consistency of the RR interval indicates a regular rhythm. (B) A normal P wave before each complex indicates the impulse originated in the SA node. (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. (D) Elevation of the ST segment is a sign of cardiac ischemia and is unrelated to the rhythm. (E) The QRS duration should be less than 0.12 seconds; the PR interval should be 0.12 to 0.2 seconds.