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A client diagnosed with mitral stenosis asks the nurse what is wrong with her heart. How can the nurse best explain this health problem?

A.

“The left side of your heart is having trouble overcoming the resistance in the blood vessels of your body.”

B.

“When your heart beats, some of the blood that should leave the left ventricle is backing up through a leaking valve.”

C.

“The valve between your heart and lungs has become inelastic.”

D.

“The mitral valve has become stiff and narrowed which slows the blood between the two chambers.”

E.

Administer 40 mg furosemide IV now

Answer and Explanation

The Correct Answer is D

a. “The left side of your heart is having trouble overcoming the resistance in the blood vessels of your body.”

  • This explanation is not specific to mitral stenosis. It describes systemic vascular resistance, which is a broader concept related to hypertension and vascular health. Mitral stenosis specifically involves narrowing of the mitral valve, which affects blood flow between the left atrium and left ventricle.

b. “When your heart beats, some of the blood that should leave the left ventricle is backing up through a leaking valve.”

  • This explanation is more accurate for mitral regurgitation rather than mitral stenosis. Mitral regurgitation involves the leaking of blood backward through the mitral valve into the left atrium during ventricular systole. Mitral stenosis, on the other hand, involves narrowing or constriction of the mitral valve, which impedes the flow of blood from the left atrium to the left ventricle during diastole.

c. “The valve between your heart and lungs has become inelastic.”

  • This explanation is not entirely accurate. While mitral stenosis does involve changes in the mitral valve structure, such as thickening and calcification, the term "inelastic" does not fully describe the pathology of mitral stenosis. Mitral stenosis is characterized by the narrowing (stenosis) of the mitral valve orifice, which restricts blood flow from the left atrium to the left ventricle.

d. “The mitral valve has become stiff and narrowed which slows the blood between the two chambers.”

  • This explanation is the most accurate description of mitral stenosis. It correctly identifies the problem as the narrowing and stiffening (stenosis) of the mitral valve, which impedes the flow of blood from the left atrium to the left ventricle during diastole. This explanation helps the client understand how the condition affects the function of the mitral valve and the flow of blood within the heart.


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Related Questions

Correct Answer is B

Explanation

a. Hemolytic anemia: Hemolytic anemia is more commonly associated with mechanical heart valves rather than tissue valves. Mechanical valves can cause damage to red blood cells as they move through the valve, leading to hemolysis and subsequent anemia. Tissue valves typically do not cause significant hemolysis.

b. Endocarditis: Endocarditis is a known complication associated with prosthetic heart valves, including tissue valves. While tissue valves generally have a lower risk of thrombosis compared to mechanical valves, they are still susceptible to bacterial colonization and subsequent endocarditis. Patients with prosthetic heart valves, regardless of type, are recommended to take antibiotic prophylaxis before certain dental or surgical procedures to reduce the risk of infective endocarditis

c. Hypertension: Hypertension is not specifically associated with tissue valve replacements. While hypertension is a common cardiovascular condition, it is not directly related to the type of prosthetic valve implanted.

d. Elevated PT/INR: Elevated prothrombin time (PT) and international normalized ratio (INR) are more commonly associated with mechanical heart valves rather than tissue valves. Mechanical valves require lifelong anticoagulation therapy with medications such as warfarin to prevent thrombosis. Tissue valves generally do not require long-term anticoagulation therapy, although they may still require short-term anticoagulation immediately after implantation.

Correct Answer is B

Explanation

Based on the expected changes in hyperventilation related to anxiety, option b (pH 7.47, PaCO2 25 mmHg, HCO3 26 mEq/L) is the most consistent with respiratory alkalosis, which occurs due to hyperventilation:

a. pH 7.49, PaCO2 36 mmHg, HCO3 31 mEq/L:

  • The pH is higher than the normal range, indicating alkalosis.
  • The PaCO2 is within the normal range (slightly elevated), which is unexpected in hyperventilation where PaCO2 is typically decreased.
  • The HCO3 is elevated, indicating metabolic alkalosis, which is not typically associated with hyperventilation related to anxiety.

b. pH 7.47, PaCO2 25 mmHg, HCO3 26 mEq/L:

  • The pH is higher than the normal range, indicating alkalosis.
  • The PaCO2 is below the normal range, indicating respiratory alkalosis, which is consistent with hyperventilation.
  • The HCO3 is within the normal range, which can occur as a compensatory mechanism for respiratory alkalosis.

c. pH 7.32, PaCO2 41 mmHg, HCO3 22 mEq/L:

  • The pH is lower than the normal range, indicating acidosis.
  • The PaCO2 is within the normal range, which is unexpected in hyperventilation where PaCO2 is typically decreased.
  • The HCO3 is within the normal range, indicating compensated metabolic acidosis, which is not typically associated with hyperventilation related to anxiety.

d. pH 7.30, PaCO2 48 mmHg, HCO3 26 mEq/L:

  • The pH is lower than the normal range, indicating acidosis.
  • The PaCO2 is elevated, indicating respiratory acidosis, which is not typically associated with hyperventilation.
  • The HCO3 is within the normal range, which can occur as a compensatory mechanism for respiratory acidosis.

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