The nurse is caring for a patient who has had a mitral valve replacement. What information does the nurse need to include in the discharge instructions?

Good dental hygiene

Activity restrictions

Diet modifications

Long term antibiotics

Answer and Explanation

The Correct Answer is A

A. Good dental hygiene: Patients with prosthetic heart valves are at increased risk for infective endocarditis. Maintaining excellent oral care, including regular brushing, flossing, and routine dental visits, helps reduce the risk of bacteremia from the oral cavity, which can seed the prosthetic valve. Patient education on this is a critical component of discharge instructions.

B. Activity restrictions: While some activity modifications may be advised initially postoperatively, most patients gradually return to normal activity levels unless otherwise indicated. General activity restrictions are not as essential as infection prevention education for long-term valve care.

C. Diet modifications: Unless the patient has comorbid conditions such as heart failure or hyperlipidemia, there are no specific diet modifications required solely due to mitral valve replacement. Nutritional education may be part of overall recovery but is not the primary discharge focus.

D. Long-term antibiotics: Prophylactic antibiotics are not routinely prescribed long-term for all patients after valve replacement. They are reserved for specific situations, such as prior to dental or invasive procedures, and should be used according to current guidelines rather than as a daily long-term regimen.

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Correct Answer is C

Explanation

A. Administer opioid analgesics every 4 hours: Opioids can reduce pain but do not address the positional component of pericardial pain, which often worsens with lying supine or deep inspiration. Opioids may be considered if NSAIDs or positioning strategies are insufficient, but they are not the first-line intervention for pain specifically caused by pericardial inflammation.

B. Increase fluid intake to reduce inflammation: While maintaining hydration is generally important, increasing fluid intake does not directly reduce pericardial inflammation or relieve the acute chest pain associated with pericarditis. This action has minimal impact on the patient’s immediate discomfort.

C. Place the patient in Fowler's position, leaning forward: Leaning forward and sitting upright relieves pericardial pain by decreasing pressure on the inflamed pericardial sac and reducing friction between pericardial layers. This position is a non-pharmacologic, evidence-based intervention specifically effective in alleviating pericarditis-related chest pain.

D. Encourage the patient to take deep, slow breaths: Deep breathing may exacerbate pericarditis pain because chest expansion increases friction of the inflamed pericardial layers. While breathing exercises are generally useful in other conditions, they are not recommended as a primary strategy for acute pericarditis pain relief.

A. "An MRI will show adhesions impairing the outflow of cerebral spinal fluid (CSF)." B. "The lumbar puncture results will show cerebral spinal fluid (CSF) that is cloudy in appearance with raised neutrophils." C. "The lumbar puncture results will show cerebral spinal fluid (CSF) that has a normal appearance with raised lymphocytes." D. "An MRI will identify meninges thickening."

Correct Answer is B

Explanation

A. "An MRI will show adhesions impairing the outflow of cerebral spinal fluid (CSF).": MRI may reveal complications such as hydrocephalus or meningeal inflammation but cannot definitively diagnose bacterial meningitis. Adhesions are not a typical finding used to confirm the infection.

B. "The lumbar puncture results will show cerebral spinal fluid (CSF) that is cloudy in appearance with raised neutrophils.": Bacterial meningitis is confirmed by analysis of CSF obtained via lumbar puncture. Cloudy CSF indicates high protein content and cellular debris, while a predominance of neutrophils (polymorphonuclear leukocytes) reflects an acute bacterial inflammatory response. CSF glucose is often low and protein elevated, supporting the diagnosis.

C. "The lumbar puncture results will show cerebral spinal fluid (CSF) that has a normal appearance with raised lymphocytes.": Normal-appearing CSF with elevated lymphocytes is more consistent with viral (aseptic) meningitis, not bacterial. This finding would not confirm bacterial infection and could mislead diagnosis and treatment.

D. "An MRI will identify meninges thickening.": MRI may show meningeal enhancement in meningitis, but it is nonspecific and cannot distinguish bacterial from viral causes. Definitive diagnosis relies on CSF analysis rather than imaging findings.

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The nurse is caring for a patient who has had a mitral valve replacement. What information does the nurse need to include in the discharge instructions?

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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