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 {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A,B,C"},"D":{"answers":"A,B,C"},"E":{"answers":"A"}}

Explanation

Assessment Findings and Rationale

1. Ambulation Pattern

Parkinson's Disease: The slow and shuffling gait is characteristic of Parkinson's disease due to muscle rigidity and bradykinesia (slowness of movement). Patients often exhibit a stooped posture and a shuffling gait.

2. Muscle Movements

Parkinson's Disease: Unilateral resting tremors and generalized muscle stiffness are hallmark signs of Parkinson's disease, which affects motor control due to basal ganglia degeneration. As the disease progresses, bilateral tremors and stiffness develop.

3. Speech

Parkinson's Disease: Slow and slurred speech is common in Parkinson's disease as a result of muscle rigidity affecting speech production.

Stroke: Speech difficulties such as slurred speech may also occur in stroke patients due to dysarthria, which arises from motor control deficits.

Multiple Sclerosis: Speech issues, including slurred speech, can also be seen in multiple sclerosis due to neurological involvement and muscle control issues.

4. Orientation Status

Parkinson's Disease: Disorientation to date and time can be seen in later stages of Parkinson's disease as cognitive decline may accompany the motor symptoms.

Stroke: Cognitive deficits, including disorientation, can result from stroke, especially if it affects the areas of the brain responsible for cognition.

Multiple Sclerosis: Orientation issues may also occur in multiple sclerosis as cognitive impairment can be part of the disease process.

5. Facial Rigidity

Parkinson's Disease: Facial rigidity, often described as a "masked face," is a classic symptom of Parkinson's disease, resulting from decreased facial muscle control.

A. Aspiration B. Gastroesophageal reflux disease C. Dumping syndrome D. Peptic ulcer disease

Correct Answer is A

Explanation

A. Dysphagia increases the risk of aspiration, especially when swallowing difficulties are present, making it essential to monitor for signs of aspiration.
B. Gastroesophageal reflux disease (GERD) is not directly related to dysphagia from a stroke.
C. Dumping syndrome occurs after certain types of gastric surgery and is not associated with dysphagia post-stroke.
D. Peptic ulcer disease is not a typical complication of dysphagia following a stroke.

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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

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client. Exhibits For each client finding, click to specify if the finding is consistent with Parkinson's disease, stroke, and/or multiple sclerosis. Each finding can support more than one disease process.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A,B,C"},"D":{"answers":"A,B,C"},"E":{"answers":"A"}}

Explanation

A nurse is caring for a client who had a stroke and has dysphagia. The nurse should monitor the client for which of the following complications?

Correct Answer is A

Explanation

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