Deck 18: Valvular Heart Disease

Question 1

A client presents with paroxysmal nocturnal dyspnea (PND)and chest pain.On auscultation,the client is found to have a holosystolic murmur at the fifth intercostal space in the left sternal border.Which condition would warrant the client to undergo an echocardiogram for validation of the disease?
1)Aortic valve insufficiency
2)Mitral valve insufficiency
3)Tricuspid valve stenosis
4)Mitral valve prolapse

Answer 1

2

Question 2

What would a nurse hear when auscultating heart sounds in a client who has hypertrophic cardiomyopathy?
1)A high-pitched,blowing,decrescendo murmur.
2)An opening snap after S₂.
3)A harsh,diamond-shaped systolic murmur.
4)A blowing holosystolic murmur.

Answer 2

3

Question 3

How does Ebstein's anomaly lead to a small right ventricular chamber?
1)The mitral valve leaflets push into the right ventricle,creating a small right ventricular chamber.
2)A displaced tricuspid valve lowers into the right ventricle,creating a small right ventricular chamber.
3)The pulmonic valve pushes into the right ventricle,creating a small right ventricular chamber.
4)The aortic valve pushes into the right ventricle,creating a small right ventricular chamber.

Answer 3

2

Question 4

A registered nurse is teaching a group of nursing students the preventive measures to be adopted for thromboemboli.Which response by a student nurse indicates effective learning?
1)"Thromboemboli is prevented through the use of antibiotics."
2)"Thromboemboli is prevented through the use of diuretics."
3)"Thromboemboli is prevented through the use of anticoagulants."
4)"Thromboemboli is prevented through the use of beta-adrenergic blockers."

Question 5

A nurse is auscultating a client's heart sounds and notices a murmur.What would differentiate a heart murmur that is caused by mitral valve stenosis than one that is caused by other mitral valve disorders?
1)Mid-systolic murmur
2)Opening snaps following a diastolic murmur
3)Holosystolic murmur
4)Late systolic murmur

Question 6

A client presents with dyspnea,exertional dyspnea,and exertional syncope.An echocardiogram shows a diminished left ventricular ejection fraction.What would be the reason for prescribing dobutamine to the client?
1)To enhance arterial circulation
2)To reduce the risk of coagulation
3)To augment the cardiac output
4)To diminish the effects of ventricular failure

Question 7

How should a nurse distinguish a grade 5 heart murmur from a grade 6 heart murmur?
1)A grade 5 heart murmur is heard with the diaphragm of a stethoscope,while a grade 6 heart murmur is heard with the bell of a stethoscope.
2)A grade 5 heart murmur may be heard when a stethoscope is partly off the chest wall,while a grade 6 heart murmur is heard when a stethoscope is off the chest wall.
3)A grade 5 heart murmur is moderately loud,while a grade 6 heart murmur is loud and has a palpable thrill.
4)A grade 5 heart murmur is faint,while a grade 6 heart murmur is moderately loud.

Question 8

A nurse is caring for a client who has aortic valve stenosis and has failed diuretic treatment.The client is not a candidate for surgery.What procedure will likely be prescribed for the client next?
1)Aortic valve replacement
2)Pacemaker insertion
3)Defibrillator therapy
4)Percutaneous aortic balloon valvuloplasty

Question 9

A client is evaluated for a heart murmur in which the murmur is found to be loud.How should the heart murmur be rated?
1)1/6
2)3/6
3)2/6
4)6/6

Question 10

At which intercostal space is auscultation of the pulmonic valve best heard?
1)The second intercostal space in the left sternal border
2)The second intercostal space in the right sternal border
3)The fifth intercostal space in the midclavicular line
4)The fourth intercostal space in the left sternal border

Question 11

A nurse who is trained in the gold standards for coronary care has to use the most sensitive method to evaluate an intracardiac lesion.Which method should the nurse choose?
1)Electrocardiogram
2)Coronary angiography
3)Echocardiography
4)Chest x-ray

Question 12

Which condition would likely be the cause of a new heart murmur in an older adult client?
1)Aortic valve sclerosis
2)Myocardial infarction
3)High blood pressure
4)Low blood pressure

Question 13

While evaluating a client for a heart murmur,a nurse auscultates the murmur with the bell of a stethoscope and not with the diaphragm of a stethoscope.Which type of heart murmur is this considered?
1)A high-pitched murmur.
2)A low-pitched murmur.
3)A crescendo murmur.
4)A decrescendo murmur.

Question 14

A client is diagnosed with mitral annular calcification and has regurgitation of blood into the left atrium and the pulmonary vasculature.What treatment should the nurse anticipate for the client?
1)Beta-blockers
2)Angiotensin converting enzyme (ACE)inhibitors
3)Diuretics
4)Digitalis

Question 15

A nurse is caring for a client who has an artificial heart valve and is scheduled for a dental procedure.Which precautionary measure should the nurse take before the dental procedure?
1)Administering diuretics
2)Administering anticoagulant therapy
3)Administering beta-blockers
4)Administering antibiotic therapy

Question 16

A client presents with dyspnea,cough,fatigue,and orthopnea.On auscultation,there is an opening snap,and a diastolic murmur heard at the fifth intercostal space in the left sternal border.The client undergoes an echocardiogram to validate a pathologic condition.Which pathologic condition would the client most likely have?
1)Mitral valve stenosis
2)Hypertrophic cardiomyopathy
3)Aortic valve stenosis
4)Aortic valve insufficiency

Question 17

Which event needs to be ruled out in a client who has a longstanding history of mitral valve stenosis and presents with tachycardia,an irregular pulse,and left-sided weakness?
1)Ischemic stroke
2)Myocardial ischemia
3)Left ventricular ischemia
4)Right ventricular failure

Question 18

How should a nurse document a client's heart murmur that begins just before S₂ and ends at S₂?
1)Late systolic
2)Early systolic
3)Late diastolic
4)Early diastolic

Question 19

A registered nurse is teaching a nursing student about aortic valve insufficiency.Which statement made by the student nurse indicates effective learning?
1)"It is a high-pitched,blowing,diastolic decrescendo murmur."
2)"It is a harsh,systolic,crescendo-decrescendo murmur."
3)"It is a high-pitched,decrescendo,blowing murmur."
4)"It is a blowing,holosystolic murmur."

Question 20

A left ventricular impulse is seen through the chest wall of a client.On palpation,a diastolic thrill is palpated along the left sternal border and a systolic thrill is palpable in the jugular notch.To which pathological condition could these symptoms be attributed?
1)Aortic valve insufficiency
2)Mitral valve insufficiency
3)Tricuspid valve stenosis
4)Mitral valve prolapse

Question 21

A client is found to have a disproportionately enlarged interventricular septum with an eccentrically hypertrophied left ventricle.Which condition would be indicated in the client?
1)Aortic valve stenosis
2)Mitral valve insufficiency
3)Hypertrophic cardiomyopathy
4)Mitral valve prolapse

Question 22

What are the clinical manifestations of aortic valve stenosis? Select all that apply.
1)Bibasilar pulmonary crackles
2)Systolic ejection murmur
3)Blowing holosystolic murmur
4)Graham Steell murmur
5)Split S₂