A client recently had aortic valve regurgitation treated with placement of a mechanical valve. Which laboratory test would be ordered for management of this type of prosthetic valve?

Brain natriuretic peptide (BNP)

Cardiac enzymes

Blood urea nitrogen and creatinine

PT/INR

Answer and Explanation

The Correct Answer is D

Brain natriuretic peptide (BNP): BNP is a hormone released by the heart in response to increased ventricular pressure and volume overload. It is typically elevated in conditions such as heart failure. While monitoring BNP levels may provide information about cardiac function and volume status, it is not specifically ordered for managing a mechanical valve.

b. Cardiac enzymes: Cardiac enzymes, such as troponin and creatine kinase (CK), are markers of myocardial damage and are typically elevated in conditions such as myocardial infarction. They are not specifically ordered for managing a mechanical valve unless there are signs or symptoms suggestive of myocardial ischemia or infarction.

c. Blood urea nitrogen and creatinine:- Monitoring blood urea nitrogen (BUN) and creatinine levels is important for assessing renal function, especially in individuals at risk of renal impairment due to factors such as medications or underlying conditions. While renal function is important in overall cardiac management, these tests are not specifically ordered for managing a mechanical valve unless there are concerns about renal function due to medications such as anticoagulants.

d. PT/INR (Prothrombin Time/International Normalized Ratio): PT/INR monitoring is crucial for managing patients with mechanical heart valves, as these valves are thrombogenic and increase the risk of thromboembolic events such as stroke or valve thrombosis. Warfarin, an oral anticoagulant, is commonly prescribed to maintain therapeutic anticoagulation. PT/INR monitoring helps ensure that the patient is within the target therapeutic range to prevent both thrombotic and bleeding complications associated with the mechanical valve.

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Correct Answer is D

Explanation

For a client with mitral stenosis who has developed atrial fibrillation, the primary concern is often controlling the heart rate and preventing complications associated with atrial fibrillation, such as thromboembolism.

a. Hydralazine: Hydralazine is an antihypertensive medication that works by dilating blood vessels to lower blood pressure. However, it is not typically used to manage atrial fibrillation. Therefore, this would not be the anticipated drug for this condition.

b. Lorazepam: Lorazepam is a benzodiazepine medication used primarily for its anxiolytic (anxiety-reducing) and sedative properties. It does not have a direct effect on managing atrial fibrillation or its complications. Therefore, it would not be the anticipated drug for this condition.

c. Enalapril: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to manage hypertension and heart failure. While it may be beneficial in some cases of heart failure, it is not typically the first-line choice for managing atrial fibrillation. Therefore, it would not be the anticipated drug for this condition.

d. Digoxin: Digoxin is a medication that increases the strength of the heart's contractions and helps control the heart rate in atrial fibrillation. It is often used in patients with atrial fibrillation, especially when there is concurrent heart failure or atrial fibrillation with rapid ventricular response. Therefore, digoxin would be the anticipated drug for managing atrial fibrillation in this scenario.

A. BNP 700pg/ml (<100pg/ml) B. Chest x-ray shows cardiomegaly C. Hematocrit 35% (37-47%) D. Echocardiogram with ejection fraction of 60% (normal is 55-75%)

Correct Answer is A

Explanation

a. BNP 700pg/ml (<100pg/ml)

Rationale: B-type natriuretic peptide (BNP) is a biomarker used to diagnose and assess the severity of heart failure. Elevated BNP levels indicate increased ventricular stretch and fluid overload, both of which are indicative of worsening heart failure. A BNP level of 700pg/ml is significantly elevated compared to the normal range (<100pg/ml) and suggests acute exacerbation or decompensation of heart failure, requiring prompt intervention and management adjustment.

b. Chest x-ray shows cardiomegaly: While cardiomegaly on chest x-ray is indicative of heart failure, it is a diagnostic finding rather than an acute result requiring immediate intervention. It would be important to address but may not require urgent reporting unless accompanied by acute symptoms.

c. Hematocrit 35% (37-47%): A hematocrit of 35% falls at the lower end. While changes in hematocrit can indicate fluid volume status, this value alone does not indicate an urgent need for intervention or adjustment of therapy. It may warrant monitoring over time, but it is not an immediate concern.

d. Echocardiogram with ejection fraction of 60% (normal is 55-75%): An ejection fraction of 60% falls within the normal range and is not indicative of worsening heart failure. While it's essential to monitor ejection fraction in heart failure patients, this result alone does not suggest acute decompensation requiring immediate intervention.

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A client recently had aortic valve regurgitation treated with placement of a mechanical valve. Which laboratory test would be ordered for management of this type of prosthetic valve?

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