The nurse is preparing a patient for mitral valve replacement surgery. Which preoperative teaching point is most important?

Choice A rationale

Atrial fibrillation is characterized by chaotic, irregular electrical activity in the atria, leading to an irregularly irregular ventricular rhythm. The EKG would show an absence of clear, distinct P waves, which are replaced by chaotic fibrillatory waves, and R-R intervals that vary significantly, unlike a regular rhythm strip.

Choice B rationale

Sinus tachycardia is a rhythm originating from the SA node with a regular rate greater than 100 beats per minute (bpm). A 6-second strip, showing R-R intervals, would demonstrate a regular rhythm with a rate above 100 bpm, and a P wave preceding every QRS complex.

Choice C rationale

Paroxysmal Supraventricular Tachycardia (PSVT) is a rapid rhythm, usually 150-250 bpm, characterized by regular R-R intervals. P waves are often hidden within the preceding T wave or QRS complex, or may appear abnormal, and the rate is significantly faster than the rhythm strip likely demonstrates.

Choice D rationale

Sinus bradycardia is a regular rhythm originating from the SA node with a heart rate less than 60 beats per minute (bpm). The EKG would display a P wave before every QRS complex, a regular rhythm, and R-R intervals that are long, indicating a slow rate, which is inferred by the widely spaced complexes. —.

Choice A rationale

Encourage incentive spirometer use is a key post-operative intervention, particularly with any thoracic or general anesthesia procedure. Deep breathing prevents pulmonary complications such as atelectasis and pneumonia, which can significantly prolong recovery and increase morbidity. Early and frequent use promotes alveolar expansion and gas exchange.

Choice B rationale

Cardiac monitoring for arrhythmias is crucial because manipulation near the aortic valve and the implanting of the new valve often involve proximity to the cardiac conduction system (e.g., the AV node). This puts the patient at high risk for developing new conduction defects like AV block, which may necessitate a temporary or permanent pacemaker.

Choice C rationale

Monitor for abdominal pain is not a primary or typical concern immediately post-TAVR. The procedure is typically performed via the femoral artery in the groin; therefore, the primary site for potential complications like bleeding or hematoma is the groin/access site, not the abdomen.

Choice D rationale

Monitor for bleeding is a critical intervention. The procedure requires large-bore access to the femoral artery (or another access point like the subclavian), which poses a significant risk for immediate post-procedure retroperitoneal or groin hemorrhage requiring vigilant monitoring of the access site and serial hemoglobin levels.