A nurse is assessing a client who has mitral valve stenosis. Which of the following findings should the nurse expect?
Barrel chest
Clubbing of the fingers
Bradycardia
A heart murmur
The Correct Answer is D
Rationale:
A. A barrel chest is typically associated with chronic obstructive pulmonary disease (COPD) due to chronic hyperinflation of the lungs, not mitral valve stenosis.
B. Clubbing occurs in chronic hypoxia conditions such as congenital heart defects or long-term lung disease. It is not a primary feature of mitral stenosis.
C. Mitral stenosis does not typically cause bradycardia. Some clients may develop atrial fibrillation, which usually causes irregularly rapid heart rates, not slowed heart rate.
D. Mitral valve stenosis narrows the mitral valve, causing turbulent blood flow from the left atrium to the left ventricle during diastole. This produces a diastolic murmur, often heard best at the apex with the client in the left lateral position.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. In acute heart failure, especially following an MI, clients are at risk for fluid volume overload. Administering a relatively large volume of isotonic fluid could exacerbate pulmonary edema and worsen heart failure. This prescription requires clarification with the provider before administration.
B. Furosemide is a loop diuretic commonly prescribed to reduce fluid overload in heart failure. This prescription is appropriate for managing pulmonary congestion and edema.
C. Monitoring electrolytes, particularly potassium, is essential in heart failure patients receiving diuretics. This helps prevent dysrhythmias and is appropriate.
D. Morphine may be used in acute heart failure to relieve anxiety and dyspnea; this prescription is appropriate as ordered.
Correct Answer is ["A","C"]
Explanation
Rationale:
A. ESR is a nonspecific marker of inflammation. In pericarditis, inflammation of the pericardium leads to an elevated ESR, reflecting the systemic inflammatory response.
B. BNP is elevated in heart failure due to ventricular stretch and volume overload. While pericarditis can affect cardiac function, BNP is not a primary diagnostic marker for pericarditis unless there is associated heart failure.
C. CRP is another nonspecific marker of inflammation. It is commonly elevated in pericarditis and correlates with disease activity and severity.
D. Blood urea nitrogen is a marker of renal function and is not typically affected by pericarditis unless there is concurrent kidney impairment.
E. TSH is used to assess thyroid function and is not related to the inflammatory process seen in pericarditis.
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