Which interventions are included in the nursing care of a patient post Transcatheter Aortic Valve Replacement (TAVR)?

Choice A rationale

Hemoptysis (coughing up blood) is more commonly associated with conditions causing elevated pulmonary capillary pressure, such as mitral stenosis or severe left-sided heart failure leading to pulmonary congestion. Aortic valve stenosis primarily causes a pressure overload on the left ventricle, which may progress to failure, but hemoptysis is not a typical initial or specific finding.

Choice B rationale

Angina on exertion is a classic symptom of severe aortic stenosis. The stenotic valve limits the blood flow from the left ventricle into the aorta, reducing cardiac output and thus, coronary artery perfusion, especially when the myocardial oxygen demand increases during physical activity, leading to chest pain.

Choice C rationale

Ascites (fluid accumulation in the abdomen) is a sign of severe right-sided heart failure, which can occur late in the progression of aortic stenosis if the left-sided failure leads to pulmonary hypertension and subsequent right ventricular strain. It is generally not an expected initial clinical manifestation of isolated aortic stenosis.

Choice D rationale

Bradycardia (slow heart rate, normal range 60-100 beats/min) is uncommon in aortic stenosis unless there is coexisting conduction system disease. The body often attempts to compensate for the fixed, low cardiac output caused by the stenosis by maintaining or slightly increasing the heart rate. —.

Choice A rationale

While chest pain (angina) is a serious complication often associated with reduced cardiac output from the rapid rate, especially in those with underlying coronary artery disease (CAD), managing the underlying rate is the most direct way to improve myocardial oxygen supply and demand balance, which is the cause of the pain.

Choice B rationale

Educating the patient is crucial for long-term management and preventing recurrence but is not the immediate, priority action for a patient presenting with an unstable, rapid ventricular response that significantly impairs cardiac output and could lead to cardiogenic shock or heart failure.

Choice C rationale

In atrial fibrillation with rapid ventricular response (RVR), the heart rate often exceeds 100 bpm, reducing the time for diastolic filling and thus significantly decreasing stroke volume and cardiac output. Therefore, the priority is to administer rate-controlling medications (e.g., beta-blockers, calcium channel blockers) to slow the ventricular response and stabilize hemodynamics.

Choice D rationale

Anticoagulation is essential to prevent systemic embolization and stroke risk due to stasis and clot formation in the fibrillating atria. However, it addresses a long-term risk and is not the immediate, life-saving priority over controlling the dangerously rapid heart rate that acutely compromises perfusion. —.