A nurse is contributing to the plan of care for a client who is 24 hr postoperative following an aortic valve replacement with a biologic valve. Which of the following interventions should the nurse include in the plan?

Apply a cooling blanket

Monitor daily weight

Provide opioid medications on an as needed basis

PTT levels

Answer and Explanation

The Correct Answer is B

A. A cooling blanket is not typically needed unless there is a fever or postoperative temperature dysregulation, which is not a standard intervention in this case.
B. Monitoring daily weight is essential following valve replacement to detect fluid retention or heart failure, which can indicate compromised cardiac function.
C. Opioid medications may be necessary, but they should be prescribed according to the client’s pain needs rather than a routine intervention.
D. PTT levels are usually monitored for clients on anticoagulants, but since the client has a biologic valve, anticoagulation therapy is not always required as with mechanical valves.

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Correct Answer is C

Explanation

A. Wearing low-heeled shoes is advisable to promote better posture and alignment, so this statement is appropriate.
B. Carrying heavy objects close to the body is a recommended practice for preventing back injury, indicating correct understanding.
C. Sitting with knees lower than hips can lead to poor posture and increased strain on the lower back, indicating a need for further clarification. The correct position should have the knees level or slightly higher than the hips.
D. Strengthening abdominal muscles is beneficial for back support and injury prevention, indicating the client understands the concept.

A. Report of dizziness B. Temperature of 39° C (102.2° F) C. Hypoglycemia D. History of cigarette smoking

Correct Answer is A

Explanation

A. A heart rate of 56/min indicates bradycardia, which can reduce cardiac output and lead to dizziness due to decreased cerebral perfusion.
B. A high temperature is not directly associated with bradycardia; fever typically causes tachycardia.
C. Hypoglycemia does not have a direct relationship with bradycardia; it is more commonly associated with symptoms like sweating, confusion, and tremors.
D. Cigarette smoking typically contributes to conditions like tachycardia and vascular constriction, not bradycardia.

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A nurse is contributing to the plan of care for a client who is 24 hr postoperative following an aortic valve replacement with a biologic valve. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

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