The nurse is caring for a client who is having a mitral valve replacement with a mechanical valve. What instructions should the nurse be sure the client understands prior to being discharged?

The valve is prone to calcification.

The client will require anticoagulation.

The valve should last for 10 to 15 years.

There is a low potential for thrombi formations so anticoagulation is not necessary.

Answer and Explanation

The Correct Answer is B

A. The valve is prone to calcification: Mechanical valves resist calcification due to their synthetic composition. Calcification is more common in bio-prosthetic valves which degrade over time under pressure.
B. The client will require anticoagulation: Mechanical valves create turbulent blood flow and have a high risk of clot formation. Long-term anticoagulation therapy, typically with warfarin, is necessary to prevent thromboembolic complications such as stroke.
C. The valve should last for 10 to 15 years: Mechanical valves generally have excellent durability and often last over 20 years. This longevity makes them suitable for younger clients who can tolerate long-term anticoagulation therapy.
D. There is a low potential for thrombi formations so anticoagulation is not necessary:
Mechanical valve surfaces are highly thrombogenic and significantly elevate the risk for clot formation. Ongoing anticoagulation is a standard and essential component of postoperative care.

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Correct Answer is D

Explanation

A. Bladder trauma: Bladder injuries are more commonly associated with lower abdominal or pelvic trauma, especially from a direct blow or pelvic fracture, not chest compression.
B. A pleural effusion: Pleural effusion refers to fluid accumulation in the pleural space, usually from infection, malignancy, or inflammation. It does not occur suddenly from blunt chest trauma.
C. Fractured pelvis: A pelvic fracture is typically caused by impact to the lower body or hip area, not by forceful chest compression against a steering wheel.
D. Cardiac tamponade: Blunt chest trauma can lead to bleeding into the pericardial sac, causing cardiac tamponade. This is a life-threatening condition where fluid compresses the heart, impairing its ability to pump effectively. It is a likely concern in cases of severe chest impact.

A. "I am ordered a bronchodilator to note lung improvement following use." B. "I will breathe in through my mouth and out through my nose. C. "I brought comfortable clothes and shoes for the test." D. "My study is scheduled for 10 AM, several hours after I eat.

Correct Answer is B

Explanation

A. "I am ordered a bronchodilator to note lung improvement following use.": Pulmonary function tests often include a bronchodilator challenge to evaluate how much lung function improves after medication, which helps assess reversibility of airway obstruction.
B. "I will breathe in through my mouth and out through my nose.": Spirometry requires breathing in and out through the mouth while using a mouthpiece, not through the nose. This ensures accurate airflow measurement and prevents air from bypassing the device.
C. "I brought comfortable clothes and shoes for the test.": Wearing loose, comfortable clothing is encouraged to avoid restricting chest expansion during the test. This statement reflects good preparation for the procedure.
D. "My study is scheduled for 10 AM, several hours after I eat.": Scheduling pulmonary function tests a few hours after eating is appropriate, as a full stomach may restrict lung expansion or cause discomfort during forced breathing maneuvers.

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The nurse is caring for a client who is having a mitral valve replacement with a mechanical valve. What instructions should the nurse be sure the client understands prior to being discharged?

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