A nurse is caring for a client who is scheduled for surgical repair of a femur fracture and has a prescription for lorazepam preoperatively. Which of the following statements made by the client should indicate to the nurse that the medication has been effective?

A. Expert opinions: While expert opinions can provide valuable insights, they are considered lower in the hierarchy of evidence. They do not undergo the rigorous testing and peer review that higher levels of evidence, such as systematic reviews and randomized controlled trials, do.

B. Credible websites: Credible websites can be a good source of information, but they are not considered the highest level of evidence. The information on websites can vary greatly in quality and may not be peer-reviewed.

C. Qualitative studies: Qualitative studies can provide in-depth information about specific topics, but they are not considered the highest level of evidence. They often involve smaller sample sizes and do not provide the same level of quantitative data as systematic reviews or randomized controlled trials.

D. Systematic review: This is correct. Systematic reviews are considered the highest level of evidence in the hierarchy. They involve a comprehensive search of multiple databases to identify all relevant studies on a particular topic, followed by a rigorous assessment of the quality of each study. The results are then synthesized to provide a comprehensive overview of the current evidence.

(A) Heart murmur: This is the most appropriate answer. Mitral valve stenosis can cause a heart murmur due to turbulent blood flow across the narrowed mitral valve. This is often heard best at the apex of the heart with the patient in the left lateral decubitus position.

(B) Clubbing of the fingers: Clubbing of the fingers is typically associated with conditions that cause chronic hypoxia, such as lung disease or congenital heart disease. It is not a common finding in mitral valve stenosis.

(C) Bradycardia: Mitral valve stenosis does not typically cause bradycardia. In fact, some patients may have a rapid heart rate (tachycardia) due to atrial fibrillation, which is a common complication of mitral valve stenosis.

(D) Barrel chest: A barrel chest is typically associated with chronic obstructive pulmonary disease (COPD) and is not a common finding in mitral valve stenosis. It refers to a rounded, bulging chest that resembles the shape of a barrel. This occurs due to overinflation of the lungs over a long period of time.