The nurse is providing discharge education to a client status post mechanical mitral valve replacement. Which statement made by the client indicates the need for further education?

I will limit lifting to 10 pounds for the next month.

I will brush my teeth at least twice a day.

I will expect to hear a clicking sound from my chest.

I will stop taking apixaban after three months.

Answer and Explanation

The Correct Answer is D

A. I will limit lifting to 10 pounds for the next month: Activity restrictions after valve replacement help prevent strain on the sternum and promote healing. Limiting heavy lifting for a defined period is appropriate and demonstrates understanding of post-operative precautions.

B. I will brush my teeth at least twice a day: Good oral hygiene is important to reduce the risk of infective endocarditis in clients with mechanical heart valves. Brushing teeth twice daily reflects proper preventive care and is encouraged.

C. I will expect to hear a clicking sound from my chest: Mechanical valves often produce an audible click due to the opening and closing of the prosthetic leaflets. Awareness of this sound prevents unnecessary anxiety and demonstrates correct patient education.

D. I will stop taking apixaban after three months: Mechanical mitral valve replacements require lifelong anticoagulation, typically with warfarin, to prevent thromboembolism. Stopping anticoagulation prematurely could lead to valve thrombosis or systemic emboli, indicating a misunderstanding that requires further education.

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Correct Answer is A

Explanation

A. Document this as normal sinus rhythm: A P wave preceding each QRS complex with a heart rate of 60–100 beats per minute indicates normal sinus rhythm. This reflects appropriate electrical conduction from the sinoatrial node through the atria and ventricles, and no immediate interventions are required beyond routine monitoring.

B. Prepare to administer intravenous atropine: Atropine is indicated for symptomatic bradycardia or heart block, not for a heart rate of 70 bpm with normal sinus rhythm. Administering atropine in this situation is unnecessary and could cause tachycardia or other complications.

C. Request a 12-lead electrocardiogram: While a 12-lead ECG can provide a more comprehensive assessment, it is not required for documentation of uncomplicated normal sinus rhythm in a stable client. Telemetry reading alone is sufficient to identify NSR in this context.

D. Assess the client's cardiac enzymes: Cardiac enzymes are indicated for suspected myocardial injury or infarction. Normal sinus rhythm with a heart rate of 70 does not suggest myocardial ischemia, so evaluating cardiac enzymes is not warranted based solely on the telemetry reading.

A. Ventricular tachycardia B. Atrial fibrillation C. Sinus bradycardia D. First-degree atrioventricular block

Correct Answer is B

Explanation

The dysrhythmia on the cardiac monitor is Atrial Fibrillation (AFib). Here is why:

Irregular Rhythm: In AFib, the atria are quivering (fibrillating) rather than contracting effectively. This leads to an "irregularly irregular" ventricular response. There is also no distinct P waves. The R-R intervals are variable
Pulse Deficit: This is the hallmark of AFib. It occurs when the heart contracts so rapidly or ineffectively that some beats don't pump enough blood to produce a palpable peripheral pulse. If you feel the radial pulse while listening to the apical heart sound, you’ll notice the apical rate is higher than the radial rate.
Sudden Palpitations and Dizziness: The loss of the "atrial kick" (which normally contributes about 20–30% of cardiac output) causes a sudden drop in blood pressure and oxygenation, leading to fatigue and lightheadedness.

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The nurse is providing discharge education to a client status post mechanical mitral valve replacement. Which statement made by the client indicates the need for further education?

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Naxlex Comprehensive Predictor Exams

The client's telemetry reading shows a "P" wave before each QRS complex and has a heart rate of 70. Which action would the nurse implement?

Correct Answer is A

Explanation

A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse assesses a rapid and irregular heart rate with a significant pulse deficit. Which dysrhythmia does the nurse expect to find on the cardiac monitor?

Correct Answer is B

Explanation

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A nurse in an urgent care center is assessing a client who reports sudden-onset palpitations, fatigue, and dizziness. The nurse assesses a rapid, irregular heart rate with a significant pulse deficit and no definitive P-waves. Which dysrhythmia does the nurse expect to find on the cardiac monitor?

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