1. ANSWER C. Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis.
2. ANSWER 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.
3. ANSWER 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.
4. ANSWER 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.
5. ANSWER 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.
6. ANSWER 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.
7. ANSWER D. Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats.
8. ANSWER C. Vegetables and whole grains are low in fat and may reduce the risk for heart disease.
9. ANSWER B. Clients’ families should be included in dietary teaching; families provide support that promotes adherence.
10. ANSWERS A and B. (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. (3) 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. (4) Elevation of the ST segment is a sign of cardiac ischemia and is unrelated to the rhythm. (5) The QRS duration should be less than 0.12 seconds; the PR interval should be 0.12 to 0.2 seconds.