CHAT valve disorders

A nurse is reviewing valve disorders with a patient. Which statement correctly describes stenosis? A. The valve does not close completely, allowing backward blood flow B. The valve opening is narrowed, making forward blood flow more difficult C. The valve allows excessive forward blood flow D. The valve causes blood to bypass the ventricles

B. The valve opening is narrowed, making forward blood flow more difficult — Stenosis means narrowing of the valve, which obstructs forward blood flow.

Which statement correctly describes valvular regurgitation? A. The valve opening becomes narrowed B. The valve fails to close completely, allowing blood to flow backward C. The valve completely prevents blood flow D. The valve increases cardiac output

B. The valve fails to close completely, allowing blood to flow backward — Regurgitation occurs when a valve is leaky and does not close properly.

The nurse remembers that left-sided valve problems commonly cause which complication? A. Pulmonary congestion B. Decreased intracranial pressure C. Peripheral neuropathy D. Increased renal perfusion

A. Pulmonary congestion — Left-sided valve dysfunction can cause blood to back up toward the lungs, resulting in pulmonary congestion.

The nurse is caring for a patient with mitral regurgitation. Which direction does blood abnormally flow when the left ventricle contracts? A. Left atrium to left ventricle B. Left ventricle to left atrium C. Aorta to left ventricle D. Right ventricle to right atrium

B. Left ventricle to left atrium — With mitral regurgitation, the mitral valve does not close completely, allowing blood to leak backward from the LV into the LA during ventricular contraction.

Why can mitral regurgitation eventually cause pulmonary congestion? A. Blood backs up into the left atrium, increasing left atrial pressure B. Blood bypasses the pulmonary circulation C. Right ventricular pressure suddenly decreases D. The aortic valve becomes obstructed

A. Blood backs up into the left atrium, increasing left atrial pressure — Increased LA pressure can cause blood and fluid to back up toward the lungs.

Which conditions are common causes of mitral regurgitation? Select all that apply. A. Rheumatic heart disease B. Mitral valve prolapse C. Infective endocarditis D. Papillary muscle rupture after MI E. Appendicitis

A, B, C, D — Rheumatic heart disease, MVP, degenerative or congenital disease, infective endocarditis, and papillary muscle rupture after MI can cause mitral regurgitation.

A patient develops sudden severe dyspnea, pulmonary edema, and hypotension following an MI. Which complication should the nurse suspect? A. Chronic mitral stenosis B. Acute mitral regurgitation from papillary muscle rupture C. Stable mitral valve prolapse D. Chronic aortic stenosis

B. Acute mitral regurgitation from papillary muscle rupture — Papillary muscle rupture following MI can cause acute severe MR, leading to pulmonary edema and hypotension and requiring urgent intervention.

Which assessments are especially important for a patient with mitral regurgitation? Select all that apply. A. Lung sounds B. Work of breathing C. Cardiac rhythm D. Daily weights E. Intake and output F. Visual acuity

A, B, C, D, E — MR can cause pulmonary congestion, dysrhythmias, and fluid overload, making respiratory assessment, rhythm monitoring, daily weights, and I&O important.

A patient with mitral regurgitation develops increasing shortness of breath and crackles. What is the nurse's priority concern? A. Pulmonary congestion B. Cerebral embolism C. Cardiac tamponade D. Dehydration

A. Pulmonary congestion — MR increases left atrial pressure and can cause fluid to back up into the lungs.

Which finding in a patient with mitral regurgitation requires the most immediate attention? A. Chronic fatigue B. Mild palpitations C. Sudden dyspnea with hypotension D. History of rheumatic fever

C. Sudden dyspnea with hypotension — Sudden respiratory distress and hypotension may indicate acute severe MR with pulmonary edema and poor perfusion.

A patient with mitral valve prolapse reports intermittent palpitations and atypical chest discomfort. Which additional finding would the nurse expect? A. Mid-systolic click with murmur B. Pericardial friction rub C. Muffled heart sounds D. Widened pulse pressure

A. Mid-systolic click with murmur — A mid-systolic click with a murmur is a characteristic finding of mitral valve prolapse.

Which symptoms may occur with mitral valve prolapse? Select all that apply. A. Atypical chest pain B. Palpitations C. Fatigue D. Lightheadedness E. Anxiety-like symptoms

A, B, C, D, E — MVP may cause atypical chest pain, palpitations or skipped beats, fatigue/lightheadedness, and anxiety-like symptoms.

A patient with mitral valve prolapse reports new chest discomfort. Which action by the nurse is most appropriate? A. Reassure the patient that chest pain is always harmless with MVP B. Assess for ischemia and instability C. Encourage strenuous exercise D. Ignore the symptom unless a murmur is present

B. Assess for ischemia and instability — Chest pain should not automatically be attributed to MVP. The nurse should assess for more serious causes and signs of instability.

Which teaching should the nurse provide to a patient with symptomatic mitral valve prolapse? A. Increase stimulant intake B. Avoid all oral fluids C. Avoid stimulants and report worsening symptoms D. Remain on strict bed rest indefinitely

C. Avoid stimulants and report worsening symptoms — Stimulants may worsen palpitations. Patients should monitor and report worsening symptoms.

A patient with mitral valve prolapse is prescribed a beta blocker. What is the expected purpose of this medication? A. Treat symptomatic palpitations B. Cure the structural valve abnormality C. Increase fluid retention D. Cause tachycardia

A. Treat symptomatic palpitations — Beta blockers may be used to decrease symptomatic palpitations associated with MVP.

A patient with mitral stenosis has narrowing of the mitral valve. Which blood flow is directly obstructed? A. Left ventricle to aorta B. Left atrium to left ventricle C. Right atrium to right ventricle D. Aorta to left ventricle

B. Left atrium to left ventricle — The mitral valve lies between the LA and LV, so mitral stenosis obstructs flow from the LA into the LV.

Why does mitral stenosis cause pulmonary congestion? A. Narrowing increases left atrial pressure, causing blood to back up toward the lungs B. The right ventricle pumps directly into the lungs C. Blood leaks backward from the aorta D. Cardiac output always increases

A. Narrowing increases left atrial pressure, causing blood to back up toward the lungs — Obstructed LA-to-LV flow raises LA pressure and causes pulmonary congestion.

Which condition is classically associated with mitral stenosis? A. Rheumatic fever B. Myocarditis C. Pericarditis D. Hypertension

A. Rheumatic fever — Rheumatic fever is a classic cause of mitral stenosis.

A patient with mitral stenosis is at increased risk for which dysrhythmia? A. Atrial fibrillation B. Ventricular fibrillation only C. First-degree AV block D. Sinus bradycardia

A. Atrial fibrillation — Increased left atrial pressure and enlargement associated with mitral stenosis increase the risk of AF.

Why does mitral stenosis increase the risk of blood clots? A. It causes severe thrombocytopenia B. Increased left atrial pressure can promote AF and blood stasis C. It causes excessive ventricular contraction D. It increases coronary artery blood flow

B. Increased left atrial pressure can promote AF and blood stasis — AF reduces effective atrial contraction, allowing blood to pool and increasing thromboembolic risk.

Which assessment findings would the nurse expect with mitral stenosis? Select all that apply. A. Dyspnea on exertion B. Orthopnea C. Paroxysmal nocturnal dyspnea D. Fatigue E. Palpitations F. Cough or hemoptysis

A, B, C, D, E, F — Mitral stenosis causes pulmonary congestion and reduced exercise tolerance and may cause AF-related palpitations.

A patient with mitral stenosis develops atrial fibrillation. Which complication becomes an increased priority for the nurse to monitor? A. Stroke B. Cardiac tamponade C. Pneumothorax D. Pericardial effusion

A. Stroke — AF promotes blood stasis and clot formation, increasing the risk of systemic embolization and stroke.

The nurse is caring for a patient with mitral stenosis. Which assessments are most important? Select all that apply. A. Lung sounds B. Oxygen saturation C. Cardiac rhythm D. Neurologic status for stroke symptoms E. Exercise tolerance

A, B, C, D, E — MS can cause pulmonary congestion, AF, decreased activity tolerance, and thromboembolic complications.

Which medications might the nurse anticipate for a patient with symptomatic mitral stenosis? A. Diuretics, beta blockers, and possibly anticoagulants B. Antibiotics only C. Thrombolytics for all patients D. Vasopressors for all patients

A. Diuretics, beta blockers, and possibly anticoagulants — These may be used to manage congestion, heart rate, and thromboembolic risk depending on the patient's condition.

Aortic regurgitation causes abnormal blood flow in which direction? A. Left atrium to left ventricle B. Left ventricle to left atrium C. Aorta back into the left ventricle D. Right ventricle into the pulmonary artery

C. Aorta back into the left ventricle — A leaky aortic valve allows blood to flow backward from the aorta into the LV.

A patient with acute aortic regurgitation suddenly develops dyspnea, hypotension, and severe pulmonary edema. How should the nurse interpret these findings? A. Expected findings requiring no intervention B. Signs of an unstable emergency C. Evidence of uncomplicated chronic AR D. Normal age-related changes

B. Signs of an unstable emergency — Acute AR can cause severe pulmonary edema, hypotension, and cardiogenic shock and may require emergency surgery.

Which finding is most associated with chronic aortic regurgitation? A. Narrow pulse pressure B. Widened pulse pressure C. Muffled heart sounds D. Pericardial friction rub

B. Widened pulse pressure — Chronic aortic regurgitation may produce a widened pulse pressure and bounding pulses.

Which findings would the nurse expect with chronic aortic regurgitation? Select all that apply. A. Fatigue B. Palpitations C. Angina D. Dyspnea or orthopnea E. Bounding pulses

A, B, C, D, E — Chronic AR may cause fatigue, palpitations, angina, dyspnea/orthopnea, widened pulse pressure, and bounding pulses.

Which condition can cause acute aortic regurgitation? A. Infective endocarditis B. Seasonal allergies C. Stable hypertension only D. Mitral valve prolapse

A. Infective endocarditis — Acute AR may result from infective endocarditis, aortic dissection, trauma, or rheumatic fever.

A patient with aortic stenosis has obstruction of blood flow from which chamber? A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle

B. Left ventricle — Aortic stenosis obstructs left ventricular outflow into the aorta.

What happens to the left ventricle in aortic stenosis? A. Afterload decreases B. Afterload increases C. Preload disappears D. Contractility always increases

B. Afterload increases — The narrowed aortic valve creates resistance against LV ejection, increasing left ventricular afterload.

Why can aortic stenosis cause poor systemic perfusion? A. Blood leaks into the left atrium B. The narrowed valve decreases forward cardiac output C. Blood bypasses the lungs D. The right atrium cannot fill

B. The narrowed valve decreases forward cardiac output — Obstruction of LV outflow limits the amount of blood reaching systemic circulation.

Which three symptoms make up the classic symptomatic triad of aortic stenosis? A. Fever, murmur, and petechiae B. Angina, syncope, and dyspnea/heart failure C. Hypotension, JVD, and muffled heart sounds D. Cough, hemoptysis, and palpitations

B. Angina, syncope, and dyspnea/heart failure — These are the classic three major symptoms associated with symptomatic aortic stenosis.

A patient with aortic stenosis experiences syncope while exercising. What is the most likely explanation? A. Increased cerebral perfusion B. Decreased cerebral perfusion from limited cardiac output C. Pulmonary embolization from valve vegetations D. Increased intracranial pressure

B. Decreased cerebral perfusion from limited cardiac output — A stenotic aortic valve limits the heart's ability to increase cardiac output during exertion, reducing cerebral perfusion and potentially causing syncope.

Why can a patient with aortic stenosis develop angina even without a coronary artery occlusion? A. Myocardial oxygen demand can exceed oxygen supply B. Pulmonary blood flow stops completely C. Venous return becomes absent D. The mitral valve leaks

A. Myocardial oxygen demand can exceed oxygen supply — Increased LV workload from aortic stenosis increases myocardial oxygen demand and can create a supply-demand mismatch.

The nurse is teaching a patient with symptomatic aortic stenosis about activity. Which statement is most appropriate? A. "Strenuous activity is encouraged." B. "Avoid strenuous activity because exertion may trigger symptoms." C. "Exercise has no effect on this condition." D. "You should remain completely immobile."

B. "Avoid strenuous activity because exertion may trigger symptoms." — Patients with symptomatic AS can develop angina, syncope, or dyspnea with exertion.

Which patient should the nurse assess FIRST? A. Patient with MVP reporting occasional palpitations B. Patient with chronic AR reporting fatigue C. Patient with mitral stenosis reporting dyspnea on exertion D. Patient with acute AR who is hypotensive with severe pulmonary edema

D. Patient with acute AR who is hypotensive with severe pulmonary edema — Acute AR with respiratory distress and poor perfusion is life-threatening and requires immediate intervention.

The nurse receives report on four patients with valve disorders. Which patient is the priority? A. Patient with MVP and a mid-systolic click B. Patient with aortic stenosis who reports new exertional syncope C. Patient with chronic AR and bounding pulses D. Patient with mitral stenosis and chronic fatigue

B. Patient with aortic stenosis who reports new exertional syncope — Syncope suggests decreased cerebral perfusion from limited cardiac output and is a major symptomatic finding of severe AS.

Which diagnostic test is most useful for evaluating valve function, valve size, and ejection fraction? A. Echocardiogram B. Urinalysis C. EEG D. Abdominal ultrasound

A. Echocardiogram — Echocardiography, including TTE or TEE, is used to evaluate valve structure/function, cardiac chamber size, and EF.

Which tests might the nurse anticipate for a patient with suspected valvular heart disease? Select all that apply. A. Echocardiogram B. ECG C. Chest x-ray D. BNP and laboratory studies

A, B, C, D — Echo evaluates valve function and cardiac structure, ECG evaluates rhythm/strain, chest x-ray can show pulmonary congestion, and BNP/labs can help assess heart failure and establish trends.

A patient receives a mechanical heart valve replacement. Which teaching is most important? A. Long-term anticoagulation may be required B. Anticoagulation is never necessary C. The valve will dissolve over time D. Antibiotics are required every day for life

A. Long-term anticoagulation may be required — Mechanical valves generally require lifelong anticoagulation to reduce thrombus formation.

Which statement about a bioprosthetic valve is correct? A. It always requires lifelong anticoagulation B. It is typically made from animal tissue and usually does not require lifelong anticoagulation C. It cannot be used for valve replacement D. It always lasts longer than a mechanical valve

B. It is typically made from animal tissue and usually does not require lifelong anticoagulation — Bioprosthetic valves are commonly made from pig or cow tissue and generally do not require lifelong anticoagulation.

The nurse is caring for a patient immediately after a valve procedure. Which finding should be reported immediately? A. New dysrhythmia B. Mild fatigue C. Desire to sleep D. Mild thirst

A. New dysrhythmia — New dysrhythmias after a valve procedure may indicate a serious complication and should be promptly reported.

Which findings after a valve procedure require immediate attention? Select all that apply. A. Hypotension B. New dysrhythmia C. Acute dyspnea D. Stroke symptoms E. Major bleeding F. Fever

A, B, C, D, E, F — Post-procedure priorities include monitoring for hemodynamic instability, respiratory compromise, bleeding, infection, neurologic changes, dysrhythmias, and recurrent heart failure.

Which assessment finding after a valve procedure is the HIGHEST priority? A. Mild incisional discomfort B. New crackles with acute dyspnea C. Decreased appetite D. Fatigue

B. New crackles with acute dyspnea — Airway and breathing take priority. New crackles and acute dyspnea may indicate pulmonary edema.

A patient after valve replacement suddenly develops facial drooping and unilateral weakness. What is the nurse's priority interpretation? A. Expected anesthesia effect B. Possible stroke or embolic event C. Normal postoperative fatigue D. Dehydration

B. Possible stroke or embolic event — Acute neurologic changes after a valve procedure may indicate stroke or embolization and require immediate action.

The nurse is prioritizing four patients. Which patient should be seen FIRST? A. Patient with mitral stenosis and chronic orthopnea B. Patient with aortic regurgitation and chronic bounding pulses C. Patient after valve replacement with sudden unilateral weakness D. Patient with MVP and occasional skipped beats

C. Patient after valve replacement with sudden unilateral weakness — Acute neurologic changes indicate a possible stroke/embolus and are a life-threatening red flag.

Which findings are considered life-threatening red flags in patients with valve disorders? Select all that apply. A. Respiratory distress B. Shock or hypotension C. Unstable dysrhythmia D. Stroke or embolic symptoms E. Major bleeding

A, B, C, D, E — These findings represent immediate threats to oxygenation, perfusion, neurologic function, or circulation and require rapid intervention.

A nurse is deciding which finding is most important when assessing a patient with a valve disorder. Which principle should guide prioritization? A. Focus only on the murmur B. Assess lungs, cardiac rhythm, and perfusion C. Prioritize chronic symptoms over acute changes D. Wait for laboratory results before assessing the patient

B. Assess lungs, cardiac rhythm, and perfusion — Valve disorders can affect pulmonary status, cardiac rhythm, and systemic perfusion, making these major nursing assessment priorities.