Question

A nurse is teaching several newly licensed nurses about cardiac valve replacement. Which of the following should the nurse include in the teaching?

Answer 1

Correct Answers:

The aortic and mitral valves are the most commonly replaced valves.

Rationale :

✍️The aortic and mitral valves are the most commonly replaced valves due to their anatomical position and susceptibility to degenerative and rheumatic disease.

✍️ The left side of the heart (where these valves are located) is subjected to higher pressures compared to the right side, making it more vulnerable to structural damage over time.

✍️ Aortic stenosis and mitral regurgitation or stenosis frequently result in clinical symptoms that require surgical intervention, including valve replacement.

✍️ These pathologies can significantly impair cardiac output, and surgical correction improves hemodynamics and quality of life.

✍️ Educating new nurses about these common procedures enhances clinical awareness and preparedness for perioperative care.

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Answer 2

Correct Answers:

Request to be scanned with a handheld metal detector when in the airport
Report hiccups to the provider
Do not wear tight clothing over the insertion area
Count your pulse for 1 min each morning.

Rationale :

👉 Request to be scanned with a handheld metal detector when in the airport

⫸ Pacemakers can be affected by full-body airport security scanners, and handheld metal detectors can interfere with pacing if held over the device too long.

⫸ Patients should inform security personnel so that alternative screening procedures can be used safely.

⫸ This instruction promotes safety and avoids potential electromagnetic interference.

👉Report hiccups to the provider

⫸ Persistent hiccups may indicate that the pacemaker lead is dislodged and stimulating the diaphragm instead of the heart.

⫸ This can be a sign of device malfunction requiring immediate medical attention.

⫸ Prompt reporting helps prevent complications from ineffective cardiac pacing.

👉Count your pulse for 1 min each morning

⫸ Monitoring the pulse daily helps ensure the pacemaker is functioning properly.

⫸ If the heart rate is significantly below the pacemaker’s programmed rate, it may indicate a problem that needs provider intervention.

👉Do not wear tight clothing over the insertion area

⫸ Tight clothing can irritate the pacemaker site or dislodge the leads during the healing phase.

⫸ Loose-fitting garments reduce pressure on the surgical site and lower the risk of complications such as lead displacement or infection.

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Answer 3

Correct Answers:

Teach community members to seek medical treatment for streptococcal pharyngitis.

Rationale :

🔹Teach community members to seek medical treatment for streptococcal pharyngitis.

🔹Rheumatic fever is a serious inflammatory condition that can develop after untreated or inadequately treated Group A Streptococcal pharyngitis.

🔹 Early recognition and full antibiotic treatment of strep throat prevent this sequela.

🔹Community education focuses on reducing the incidence by addressing the root cause—untreated streptococcal infections.

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Answer 4

Correct Answers:

Patient with infecting endocarditis having new onset flank pain and hematuria

Rationale :

A client with infective endocarditis who suddenly develops flank pain and hematuria is exhibiting signs of systemic embolization, which can be life-threatening.
Vegetations from infected heart valves may embolize and lodge in the renal arteries, resulting in renal infarction.
This complication requires immediate assessment and intervention due to the risk of renal failure and systemic sepsis.
Compared to other patients listed, this client presents the most acute change in condition, and prioritization of care is based on new onset, potentially life-threatening symptoms.

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Answer 5

Correct Answers:

Echocardiogram

Rationale :

✍️The echocardiogram is the primary diagnostic tool used to evaluate for cardiac tamponade, a critical complication in which fluid accumulation in the pericardial sac compresses the heart, limiting its ability to pump effectively.

✍️ It provides real-time visualization of pericardial effusion, chamber collapse, and ventricular filling.

✍️This noninvasive, fast, and sensitive modality can confirm tamponade and guide emergency interventions like pericardiocentesis.

✍️ While ECG and chest X-ray may show suggestive findings, they are not as definitive or immediate in guiding clinical decisions in tamponade cases.

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Answer 6

Correct Answers:

Rheumatic fever

Rationale :

🔸Group A Streptococcal pharyngitis, if left untreated, can result in rheumatic fever, a serious systemic inflammatory condition that can cause permanent damage to the heart valves.

🔸 Early antibiotic therapy is essential not only to treat the infection but also to prevent the autoimmune response that leads to rheumatic heart disease.

🔸 Prevention of this sequela underscores the importance of timely identification and full antibiotic treatment of strep throat, especially in pediatric and adolescent populations.

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Answer 7

Correct Answers:

Prepare for transcutaneous pacing

Rationale :

💎 A heart rate of 45 bpm with hypotension (82/60 mm Hg) and symptoms of dizziness indicate symptomatic bradycardia, which is a medical emergency.

💎 The first-line treatment for unstable bradycardia, especially if unresponsive to atropine or if atropine is contraindicated, is transcutaneous pacing.

💎 This noninvasive technique delivers electrical impulses to stimulate cardiac activity and maintain adequate perfusion until a more permanent solution is arranged.

💎 Prompt initiation of this therapy can prevent cardiac arrest.

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Answer 8

Correct Answers:

Valvular heart disease.

Rationale :

👉Rheumatic fever is an autoimmune inflammatory disease that commonly affects heart valves, especially the mitral and aortic valves.

👉The inflammation leads to chronic scarring and deformity, resulting in valvular stenosis or regurgitation, often years after the initial infection.

👉This condition is a leading cause of acquired valvular heart disease in young adults, especially in areas where streptococcal infections are poorly managed.

👉 Discussing long-term sequelae like this helps patients and providers recognize the importance of early treatment and long-term monitoring.

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Answer 9

Correct Answers:

Pericardiocentesis

Rationale :

💎 The presentation of hypotension, dyspnea, tachycardia, and distended neck veins strongly suggests cardiac tamponade.

💎This is a life-threatening emergency caused by pericardial fluid accumulation compressing the heart.

💎Pericardiocentesis is the emergent procedure that involves inserting a needle into the pericardial space to drain the fluid and restore normal cardiac function.

💎 It is the definitive treatment to relieve pressure and improve hemodynamics.

💎 Delay in this intervention can result in pulseless electrical activity and death.

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Answer 10

Correct Answers:

Smoking cigarettes
Family history of aneurysm
Diabetes mellitus

Rationale :

✅ Smoking cigarettes

Smoking is a major risk factor for developing abdominal aortic aneurysm (AAA) due to its role in promoting atherosclerosis and weakening the vascular wall.
It is considered the most modifiable contributor to aneurysm formation and progression.

✅ Family history of aneurysm

A positive family history indicates a genetic predisposition to aneurysmal disease.
Such patients are at increased risk for developing AAA and must be screened and monitored even in the absence of symptoms.

✅ Diabetes mellitus

Its relationship with aneurysms is complex, but diabetes contributes to chronic vascular inflammation and arterial wall degeneration, which can promote aneurysm development.

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RN Medsurg Nur46 Exam

No.

1 : A nurse is teaching several newly licensed nurses about cardiac valve replacement. Which of the following should the nurse include in the teaching?

2 : A nurse is teaching a client who is postoperative following the insertion of a permanent pacemaker. Which of the following instructions should the nurse include? (Select all that apply.)

3 : Which action should the nurse include in a community health program to decrease the incidence of rheumatic fever?

4 : After receiving shift change report, which of the following patients should the nurse see first?

5 : A nurse is planning care for a client who has suspected cardiac tamponade. Which of the following diagnostic tests should the nurse anticipate the provider to order first?

6 : A patient has been diagnosed with Group A Streptococcal pharyngitis. The nurse recognizes the need for antibiotic therapy to help prevent the development of which serious condition

7 : A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention should the nurse anticipate will be prescribed?

8 : When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of

9 : A patient admitted with a diagnosis of pericarditis develops hypotension, shortness of breath, tachycardia, and distended neck veins. Which of the following procedures would the nurse anticipate assisting with for this emergent situation?

10 : Which of the following are risk factors for abdominal aortic aneurysm (AAA)? (Select all that apply.)

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