ADV Med-Surg Questions Exam 2 questions with solutions and rationales.

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ADV Med-Surg Questions Exam 2 questions with solutions and rationales. A 68-year-old woman is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Alth... ough 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) Chicken pox B) Poliomyelitis C) Rheumatic fever D) Meningitis - Ans-C) Rheumatic fever Rationale: Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis. 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 - Ans-A) Exertional dyspnea Rationale: Weight gain, due to fluid retention and worsening heart failure, causes exertional dyspnea in clients with mitral regurgitation. The nurse expects that a client with mitral stenosis would demonstrate symptoms associated with congestion in the: A) Aorta B) Right atrium C) Superior vena cava D) Pulmonary circulation - Ans-D) Pulmonary circulationRationale: 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. 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 - Ans-A) Medication therapy Rationale: 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 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 - Ans-A) A manual toothbrush Rationale: 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. 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 emboliC) Fever D) Congestive heart failure - Ans-B) Systemic emboli Rationale: 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. [Show More]

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