A nurse is assessing a client who has valvular dysfunction. Which of the following manifestations should the nurse anticipate? (Select All That Apply)
Varicose veins
Heart murmur
Palpitations
Abdominal pain
Chest pain
Correct Answer : B,C,E
A. Varicose veins: Varicose veins are dilated, twisted veins that commonly occur in the legs and are typically associated with venous insufficiency or venous valve dysfunction rather than valvular dysfunction of the heart.
B. Heart murmur: This is the correct answer. Valvular dysfunction can result in abnormal blood flow patterns across the heart valves, leading to turbulent blood flow and the production of audible heart murmurs upon auscultation.
C. Palpitations: Palpitations, or the sensation of rapid, pounding, or irregular heartbeats, can occur with valvular dysfunction, particularly if the dysfunction leads to alterations in heart rhythm or cardiac output.
D. Abdominal pain: Abdominal pain is not typically associated with valvular dysfunction. It may be a symptom of various gastrointestinal or abdominal conditions, but it is not a direct manifestation of valvular heart disease.
E. Chest pain: This is the correct answer. Chest pain can occur with valvular dysfunction, especially if the dysfunction leads to inadequate blood flow to the heart muscle (ischemia), which can cause angina or chest discomfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "I can't eat as much as I used to": While changes in eating habits may be related to various factors, such as appetite changes or difficulty chewing/swallowing, this statement does not specifically indicate how hearing loss affects the client's ability to perform ADLs.
B. "I get dizzy when I nod my head": This statement suggests that the client is experiencing dizziness, which could be related to hearing loss affecting their sense of balance. Dizziness can significantly impact the client's ability to perform activities of daily living (ADLs) safely, such as walking, cooking, or bathing, as it increases the risk of falls and injury.
C. "I wash my hair every other day": This statement describes a personal hygiene habit and does not directly indicate how hearing loss affects the client's ability to perform ADLs.
D. "I walk my dog at least twice a day": This statement describes an activity the client engages in and does not directly indicate how hearing loss affects the client's ability to perform ADLs. Walking a dog does not necessarily require hearing ability, as it primarily involves physical movement and visual observation.
Correct Answer is C
Explanation
A. Third spacing: Third spacing refers to the shifting of fluid from the intravascular space into the interstitial space, leading to decreased circulating volume. While third spacing can contribute to hypovolemic shock, it is not specific to obstructive shock.
B. Cardiomyopathy: Cardiomyopathy is a condition characterized by abnormalities in the heart muscle structure and function. While cardiomyopathy can lead to heart failure, it is not directly associated with obstructive shock.
C. Cardiac tamponade: Cardiac tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and impairing its ability to fill properly. This condition can lead to obstructive shock due to decreased cardiac output. Signs and symptoms include hypotension, muffled heart sounds, distended neck veins, and pulsus paradoxus.
D. Ruptured aneurysm: A ruptured aneurysm can lead to hypovolemic shock due to acute blood loss. While it can cause significant hemodynamic instability, it is not a characteristic diagnosis of obstructive shock.
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